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United States Public Health Service 
Bureau Circular Letters. 






TREASURY DEPARTMENT 

UNITED STATES PUBLIC HEALTH SERVICE 



BUREAU CIRCULAR LETTERS 



1913-1920 



PREPARED BY DIRECTION OF THE SURGEON GENERAL 




WASHINGTON 
GOVERNMENT PRINTING OFFICE 

1921 



-J 






^ C^ ^ 



BUREAU CIRCULARS. 



The Occurrence of Quarantinable Diseases to be Reported by Telegraph. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, January 13, 1913. 

Bnrean Circular Letter No. 1. 

To Tnedical officers of the United States Public Health Service: 

You are directed to report to the Surgeon General by telegraph 
whenever cases of cholera, plague, or yellow fever, or any other 
dangerous communicable disease, becomes epidemic at any port or 
place, or in the vicinity of any port or place at which you are sta- 
tioned. You are further directed to report by telegraph weekly 
thereafter on Saturday the status of the outbreak, giving, whenever 
possible, the number of cases and deaths known to have occurred 
during the preceding week and the total number from the beginning 
of the outbreak. The subsidence or disappearance of the outbreak 
is also to be reported by telegraph. 

Rupert Blue, Surgeon General. 



Necessity for Economy in the Expenditures Chargeable to the Appropriation 
for Maintenance of Marine Hospitals, 1913. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, January 17, 1913. 

Bureau Circular Letter No. 2. 

To commissioned officers, acting assistant surgeons, and others con- 
' cerned: 

On account of the limited amount of the appropriation for the 
maintenance of marine hospitals, it has become necessary to institute 
the most rigid economy in expenditures chargeable to that appro- 
priation. It will be necessary until further notice to cut down 
these expenditures to the lowest possible limit. You will especially 
avoid making purchases under paragraph 654 of the regulations, 
except for the most urgent necessities. 

You will acknowledge receipt of this letter. 

Rupert Blue, Surgeon General. 
(3) 



I 



Tools for Use in Care of Buildings and Grounds. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, February 11^ 1913. 

Bureau Circular Letter No. 3. 

To commissioned officers, acting assistant surgeons, and others con- 
cerned: 
By direction of the department, under date of January 24, 1913, 

you are informed that the appropriations under the control of the 

Supervising Architect, Treasury Department, are not available for 

the purchase of tools to be used in the care of buildings and grounds 

at marine hospitals and quarantine stations, , 

Expenditures for such tools are chargeable to the appropriations 

for the Public Health Service, and vouchers are to be rendered 

accordingly. 

EuPERT Blue, Surgeon General. 



Prevention of Spread of Tuberculosis Among Merchant Seamen. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, February 27, 1913. 

Bureau Circular Letter No. 4. 

To commissioned officers, acting assistant surgeons, and others con- 
cerned: 

In order to aid in the prevention of the spread of tuberculosis 
among seamen of the merchant marine, the following rules shall be 
-observed whenever practicable : 

Whenever a seaman suffering with tuberculosis of the lungs applies 
for treatment at a relief station of the service, the medical officer or 
acting assistant surgeon in charge thereof shall notify the master or 
accredited agent of the vessel on which said seaman sailed imme- 
diately preceding his application for relief; and if said vessel is in 
port, shall, with the consent and aid of the master, owner, or agent 
of the vessel, disinfect the forecastle or other apartment previously 
occupied by the aforesaid seaman. 

The method of disinfection shall be as follows : 

1. Thorough mechanical cleansing of floors, walls, and bunks with 
hot water and concentrated lye. 

2. Wetting floors, walls, and bunks with the following solution : 

Parts. 

Carbolic acid - 5 

Water 100 



Clothing and bedclothing which the patient has used should be 
immersed in this solution for 24 hours, unless disinfected in a steam 
chamber. 

Forecastles should be painted or whitewashed after disinfection 
when practicable. 

Masters, owners, and agents of vessels should be informed of the 
importance of compliance with the provisions of this circular. 

A report shall be rendered to the bureau of every forecastle disin- 
fected under the provisions of this circular as soon as the disinfec- 
tion shall have been effected. 

KuPERT Blue, Surgeon General. 



Freight and Express Charges to be Included in Monthly Statement of 
Expenditures and Liabilities. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington., March 11, 1913. 

Bureau Circular Letter No. 5. 

I'o commissioned officers, acting assistant surgeons, and others con- 
cerned: 
Hereafter the monthly statement of expenditures and liabilities 

(Form 1955) at your station must include freight and express 

charges on all articles received by you from transportation companies 

during the month. 

The charges as billed at the commercial rate should be ascertained 

in each case from the agent of the last transportation company 

handling the shipment on receipt by you of notice of its arrival. 
The items are to be reported under the heading and in the manner 

indicated below : 

Freight, transportation, and travel expenses. 



Name of payee. 


Object. 


Amount. 


Pennsylvania R. R. Co 


Transportation of tents, etc., shipped Aug. 12, 1913 


$20 36 









You will acknowledge receipt of this letter. 

Rupert Blue, Surgeon General. 



Relative to Revision of Uniform Regulations. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, March 18, 1913. 

Burean Circular Letter No. 6. 

To commissioned m,edical offhcers. United States Public Health 

Service : 

A revision of the Regulations Governing the Uniforms of Officers 
and Employees of the Public Health and Marine Hospital Service 
of the United States, approved July 1, 1904, is under contemplation. 
Medical officers are therefore requested to forward to the bureau 
any suggestions as to changes or amendments to the present regula- 
tions which may appear desirable from their experience either at 
the marine hospitals, quarantine stations, or in the field. 

Suggestions should be submitted in paragraph form as amend- 
ments to present paragraphs, giving number of same, or new para- 
graphs with proper place of insertion. 

Rupert Blue, Surgeon General. 



Instructions Relative to the Preparation of Vouchers. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, March 19, 1913. 

Bureau Circular Letter No. 7. 

To commissioned officers, acting assistant surgeons. Public Health 

Service, and others concerned: 

In connection with Bureau Circular Letter No. 11, issued August 
15, 1912, relative to the adoption of new public voucher forms, it is 
directed that the disbursing clerk's check inclosure blank attached 
to each form be completely and correctly filled in at the station be- 
fore the voucher is forwarded to the bureau for approval and pay- 
ment. 

No bills are to be rendered on old editions of vouchers 1949a, 1949b, 
or 1926, approved prior to June 21, 1912, and any such forms now 
on hand at stations should be destroyed and requisition made imme- 
diately for a supply of the new forms, if none are on hand. 

Rupert Blue, Surgeon General. 



Designation of Officers in Charge of Stations. 

Treasury Department, 
Bureau oe the Public Health Service, 

Washington^ June 7, 1913. 

Bnreau Circular Letter No. 8. 

To medical oncers, United States Puhlic Health Service^ and others 

concerned: 

It is hereby directed that hereafter medical officers in charge of 
stations of the service shall be designated and addressed as " Medical 
officer in charge." The term " Medical officer in command " will be 
no longer used in this connection. 

This order does not apply to a station where the officer in charge 
has a special title or designation, such as " Chief quarantine officer," 
" Director of the Hygienic Laboratory, " Director of the Leprosy 
Investigation Station," etc. 

An officer in temporary charge of a station, in signing official cor- 
respondence, should add the words " In temporary charge " after his 
official title. 

Rupert Blue, Surgeon General. 



Prevention of Malaria. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, June ^7, 1913. 

Bareau Circular Letter No. 9. 

To owners., agents., captain^s^ and members of crews of registered, 
licensed, or enrolled vessels of the United States, and others con- 
cerned: 

On account of the prevalence of malaria along certain of the rivers, 
lakes, and other bodies of water in the United States, and the lia- 
bility to exposure of persons employed on vessels plying on such 
bodies of water, measures should be taken to prevent malaria infec- 
tion or the development of the infection should it be contracted. 

The taking of quinine will largely prevent the development of 
malarial fever in those exposed. It is advised, therefore, that per- 
sons in malarial regions take one of the salts of quinine in 5-grain 
doses morning and evening every Saturday and Sunday during the 
season in which the disease prevails. 

Beneficiaries of the service may, upon application at a marine 
hospital office, obtain sufficient quinine to last one month for the pur- 
pose stated, and this supply may be renewed when necessary. Mala- 
ria is transmitted to human beings only by the bites of infected mos- 



8 

quitoes. To guard against infection, therefore, the breeding of these 
insects should be prevented and living apartments should be screened. 

Rupert Blue, Surgeon General. 



Transmitting Copy of Service Regulations. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ July 19, 1913. 

Bureau Circular Letter No. 10. 

To medical officers, United States Public Health Service, and others 
concerned: 

There is inclosed herewith a copy of the revised edition of the 
Regulations of the United States Public Health Service, approved 
March 4, 1913. 

Acknowledgment of its receipt is directed for the records of the 
bureau. 

Rupert Blue, Surgeon General. 



Proposals and Bills Chargeable to the Supervising Architect's Fund to be 

Sent to Him Direct. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, Seftemher 17, 1913. 

Bureau Circular Letter No. 11. 

To custodians of the United States marine hospitals and quarantine 

stations : 

You are informed that hereafter bills payable from appropria- 
tions under control of the Supervising Architect should be forwarded 
to him direct, instead of through the bureau as formerly. 

Proposals for work chargeable to these appropriations, the requisi- 
tions for which have been forwarded through the bureau, should also 
be forwarded direct to the Supervising Architect. 

Rupert Bluf, Surgeon General, 



Antityphoid Vaccine Available for Distribution by Hygienic Laboratory. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, August 22, 1912. 

Bureau Circular Letter No. 12. 

To coTTimissioned medical officers. United States Public Health Serv- 
ice, and other concerned: 

Referring to Bureau Circular Letter No. 2 of May 5, 1911, rela- 
tive to the administration of antityphoid vaccination to beneficiaries 



of the service, you -are informed that the Hygienic Laboratory is in 
a position to furnish such doses of this prophylactic as may be needed 
for use at first and second class stations. The bureau expects that 
opportunity will be taken to extend as much as possible among bene- 
ficiaries of the service the voluntary use of antityphoid vaccine, 
which experience has demonstrated to be of value in the prevention 
of the disease. 

Requisitions for the necessary vaccine should be addressed direct 
to the Hygienic Laboratory as the occasion arises for its use. 

The number of persons who have received preventive inoculations, 
and other pertinent data in relation thereto, should be reported to the 
bureau at the close of the fiscal year. 

Rupert Blue, Surgeon General. 



Requisitions for Stationery, Blanks, and Blank Books. 

Treasury Department, 
Bureau op the Public Health Service, 

W ashington.^ October -^, 1913. 

Burean Circular Letter No. 13. 

Medical officers^ United States Public Health Service., and others 

concerned: 

Your attention is invited to paragraphs 634 and 635, Regulations 
of the United States Public Health Service (1913) prescribing the 
dates for making requisitions for stationery, blanks, and blank books. 

It is desired that the provisions of these paragraphs be observed, 
except in case of emergency or an unforeseen necessity, in which cir- 
cumstances the requisition should be accompanied by an explana- 
tory statement, which may be written on or attached to the requisition 
or embodied in an accompanying letter. 

Attention is also invited to the fact that it is no longer necessary 
to transmit these requisitions in duplicate. 

Rupert Blue, 

Surgeon General. 

Instructions Relative to Preparing Monthly Reports of Patients Admitted and 
Discharged from Hospital. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, August 30, 1912. 

Bureau Circular Letter No. 14. 

To commissioned medical officers, acting assistant surgeons, and 

others concerned: 

The following instructions will hereafter be observed in prepar- 
ing the monthly report (Form 8998) of the admission and discharge. 



10 

together with other data, of patients treated in hospital at first and 
second class stations of the service : 

1. Reports should be prepared in typewriting. 

2. The nativity of seamen may be abbreviated if such abbreviation 
can be understood. 

3. Under "Dates of last continuous service" only the period of 
service, or services, which entitles a patient to relief should be given. 
The dates of service should be given in numerals, as 3.14.12 to 7.16.12. 

4. Care should be taken to give the correct paragraphs of the regu- 
lations under the provisions of which a patient is admitted to treat- 
ment. 

5. Dates of extension of treatment should not be given. 

6. Dates of admission and discharge should be given in numerals, 
as (admitted) 7.13.1911 or '11, (discharged) 8.17.1912 or '12. 

7. The date of first admission recorded on each page should be given 
in month, day, and year, but in the following dates of admission 
given on the same page the continuation of the same month and year 
should be dittoed ("). 

8. In record of discharges the month, day, and year should be 
given in each case. 

9. The condition of each patient upon termination of hospital 
treatment should be reported as " Rec," " Imp.," " Not Imp.," or 
" Death." 

10. If a foreign seaman is admitted to hospital treatment, the 
words " Foreign seaman " should be written in column for dates of 
service, and the name of the country responsible for the cost of his 
treatment should be given in the column for remarks. 

11. No signature of officers or remarks, such as " Continuation," 
etc., should be given on reports. 

12. Under column for diseases the distinctive title of a disease or 
injury should be given first and then followed by such modifying 
terms as may be necessary. Example : Malarial fever, int. ; syphilis, 
sec. ; valvular disease of heart, mitral. 

13. In only the report for the month of July each year, a complete 
record of patients remaining under treatment from the previous 
month should first be taken up, after which followed by a record of 
patients admitted during July. 

14. Patients who are discharged but who were admitted to hospital 
treatment during some previous month or year should be reported 
on Form 1958. In this form the word " Remarks " should be changed 
to " Result." 

15. Monthly reports of hospital patients should be prepared and 
forwarded to the bureau as soon as practicable after the first day of 
the month following that for which the reports are rendered. 



11 

16. The mailing tubes in which the reports are to be forwarded 
to the bureau should be wrapped in heavy manila paper. 
You will acknowledge the receipt of this letter. 

Rupert Blue, Surgeon General. 



Changes in the Personnel to be Reported in Duplicate. 

Treasuey Department, 
Bureau or the Public Health Service, 

'Washington^ October ^^, 1913. 

Bureau Circular Letter No. 15. 

To medical officers in charge.. United States Public Health Service: 
At the request of the Treasury Department, you are directed, on 

and after November 1, 1913, to submit all recommendations for 

changes in the personnel of the service in duplicate. 

This refers to all letters reporting resignations and discontinuances, 

and recommending appointments, promotions, and changes of detail, 

and will necessitate making a carbon copy of all letters on these 

subjects addressed to the bureau. 

KuPERT Blue, Surgeon General. 



Relative to Purchase of Neosalvarsan. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington., October ^P, 1913. 

Bureau Circular Letter No. 16. 

To medical officers., United States Public Health Service: 

It is hereby directed that neosalvarsan shall not be purchased 
hereafter under the exigency paragraph of the regulations, as it will 
be furnished by the Purveying Depot on requisitions approved by the 
bureau. 

Rupert Blue, Surgeon General. 



Relative to Reporting Patients Suflfering with Enteric Fever. 

. Treasury Department, 
Bureau or the Public Health Service, 

Washington^ October 30, 1913. 

Bureau Circular Letter No. 17. 

To medical officers, United States Public Health Service, and customs 

officers : 

Hereafter the names of all patients suffering with enteric fever 
shall be reported to this bureau by letter immediately upon their 
admission to treatment. 



12 

In each case the name of the patient, permit number, date of ad- 
mission to treatment, and name of the last vessel upon which service 
is claimed should be given. 

Rupert Blue, Surgeon General. 



Relative to Requisitions for Neosalvarsan. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ Noverriber 15, 191S. 

Bureau Circular Letter No. 18. 

To medical oficers, United States PvMic Health Service, and customs 

o fleers : 

Bureau Circular Letter No. 16, dated October 29, 1913, relative to 
the purchase of neosalvarsan, is hereby amended to read as follows : 

Neosalvarsan will be furnished bj' the Purveying Depot on requisitions for 
one month's supply, approved by the bureau. Additional requisitions should 
be made each month as required, and the names of the seamen who have re- 
ceived this drug during the previous month should be reported to the bureau. 

The bureau desires to encourage the use of neosalvarsan, as it believes that 
the number of days of hospital relief will be greatly diminished thereby ; but 
the necessity of carefully watching the condition of the appropriations for 
marine hospital relief requires that the bureau should be kept advised each 
month of the quantity employed. 

Rupert Blue, Surgeon General. 



Admissions to Hospital Treatment at Second, Third, and Fourth Class 
Stations to be Limited to Absolutely Necessary Cases. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, November IS, 1913. 

Bureau Circular Letter No. 19. 

To medical oflcers, acting assistant surgeons, and others concerned: 
You are informed that on account of the limited a]3propriation for 

care of seamen and other purposes it will be necessary to limit as 

far as possible the number of cases admitted to hospital treatment 

at your station. 

You will be notified should the condition of the appropriation later 

on warrant a more liberal expenditure than at present. 

Paragraph 494, Regulations, Public Health Service, 1913, should 

be carefully followed, and seamen requiring hospital treatment for 

a period greater than 20 days should, if they are able to travel, be 

sent at once to the nearest marine hospital. 



13 

A report should be made to the bureau of the condition of any 
seaman who has been under treatment in a contract hospital at a 
second-class station for more than 20 days, as now required of third 
and fourth class stations. 

Strict compliance with this letter is ordered, and you will acknowl- 
edge receipt of the same. 

KuPBRT Blue, Surgeon General. 



Instructions Relative to New Pay-Roll Blanks. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, November 18, 1913. 

Bureau Circular Letter No. 20. 

To commissioned officers and acting assistant surgeons, United States 

PuMic Health Service, and others concerned : 

There is transmitted herewith a supply of the new pay-roll blanks, 
Forms 1952 or 1952A, which are to be used hereafter. 

All of the old pay-roll blanks, 1951 or 1952, which may be on hand, 
are to be immediately destroyed, and requisition should be made in 
the usual manner for an additional supply of the new pay rolls if 
needed. 

Instructions relative to the preparation of the new forms will be 
found on the reverse of Form 1952. 

It should be noted that for the purpose of computing pay of per- 
sons receiving an annual or monthly compensation, each and every 
month shall be held to consist of 30 days ; but in order to receive full 
salary for a 31-day month, each and every day must be served and 
period of service should be stated on the roll, as from the 1st to the 
31st, and number of days as 31. 

The Comptroller of the Treasury has decided that one day's pay 
shall be deducted from an employee not on pay status on the last day 
of a 31-day month. 

HuPERT Blue, Surgeon General. 



Estimates for Hospital Equipment. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington., November 22, 1913. 

Bureau Circular Letter No. 21. 

To medical officers in charge United States Marine hospitals: 

The bureau desires to know what equipment will be necessary to 
place your station in first-class condition. You are therefore directed 



14 

to send an estimate giving the cost in detail, under the heads in the 
inclosed list, of all articles that will be required for this purpose. 
The estimate should be a liberal one and embrace all new and up-to- 
date appliances necessary to make your equipment as complete as 
that of any hospital in the country. You should consult recent cata- 
logues of hospital supply houses and current medical and hospital 
journals to be sure that nothing is overlooked. 

This estimate should be forwarded not later than December 15, 
as the bureau wishes to present a general estimate for the complete 
equijDment of all marine hospitals before January 1, 1914, to the 
Secretary for his approval, with a view to asking Congress for an 
appropriation to cover this expenditure. 

Rupert Blue, Surgeon General. 



Money Needed at Marine Hospitals for Remainder of Fiscal Year 1914. 

Treasury Department, 
Bureau of the Public HLealth Service, 

Washington^ Decemter i, 1913. 

Bureau Circular Letter No. 22. 

To medical o-fjicers in charge United States Marine Hospitals : 

You are requested to send to the bureau without delay a statement 
giving the amount of money, above the allotment made November 23, 
that will be needed for your station for the period from January 1 
to June 30, 1914. 

In order that no misunderstanding may arise, the amount already 
allotted to your station should be given, as well as the additional sum 
required. The statement should show, under separate heads, what 
will be necessary for subsistence, exigency purchases, hospital equip- 
ment, additional attendants, and miscellaneous articles and services 
furnished under annual contract or informal proposals approved by 
the department. 

The hospital equipment should embrace only such articles as are 
immediately needed, such as tools, cooking utensils, stoves, hospital 
furniture, repairs to ambulance, surgical instruments, lumber, etc. 
Articles not required immediately should be placed upon the list 
which you have been requested to forward by circular letter No. 21. 

Additional attendants should include two trained nurses, at $60 
per month each, for every 25 patients, one to act as day nurse and 
the other as night nurse, the present nurses and orderlies to be 
placed under their charge. Additional pay for attendants now on 
duty should also be added to this item in those cases where there has 
been difficulty in obtaining the services of efficient persons. 



15 

A letter of transmittal should accompany this statement, giving in 
detail the reasons for asking for a larger allotment for your station ; 
officers are cautioned not to request more money than will be neces- 
sary to run their stations properly for .the time specified. 

These statements and letters will be submitted to the Secretary 
with the request that Congress be asked for a deficiency appropria- 
tion to cover the expenditure. You should not, however, allow the 
expenses of your station to exceed the present allotment until notice 
is received by you that Congress has granted additional funds. 

Rupert Blue, Surgeon General. 



Relative to Transmittal of Requisitions for Medical Supplies. 

Tkeasttrt Department, 
Bureau of the Public Health Service, 

Washington, December 16, 1913. 

Barean Circniar Letter No. 23. 

To medical officers in charge first, second, and third class stations, 
Public Health Service : 

You are advised that hereafter all requisitions in whole or in part 
for supplies customarily issued by the Purveying Depot should be 
sent directly to the Medical Purveyor, 1414 Pennsylvania Avenue 
NW., Washington, D. C. 

You will acknowledge receipt of this letter. 

Rupert Blue, Surgeon General. 



Relative to Use Made of Cumulative Tables in Public Health Work. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, December £7, 1913. 

Bureau Circular Letter No. 24. 

To medical officers. United States Public Health Service^ and State 
quarantine officers. 

Sir : In the Public Health Reports there have been published for 
many years cumulative tables of the reported occurrences of cholera, 
yellow fever, plague, and smallpox in foreign countries. These 
tables have been begun anew with the 1st of January and the 1st of 
June of each year, being cumulative for a period of six months. 

It is desired to ascertain to what extent the information contained 
in these cumulative tables is of use to service officers in quarantine 
work. In acknowledging the receipt of this letter you are requested 
to inform the bureau as to what use, if any,- you have made of these 



16 

tables while engaged in maritime quarantine duty. An expression 
of your opinion as to their usefulness will also be appreciated. 

The cumulative table above referred to should not be confused 
with the current weekly noncumulative tables of cholera, yellow 
fever, plague, and smallpox in foreign countries which are also pub- 
lished in the Public Health Reports. 
Respectfully, 

Rupert Blue, Surgeon General. 



Necessity for Exigency Purchases to be Given on Face of Vouchers. 

Treasury Department, 
Bureau of the Public Health Service, 

'Washington^ December ^7, 191S. 

Bureau Circular Letter No. 25. 

To confhinissioned 'medical officers and acting assistant surgeons^ 
United States Public Health Service^ and others concerned: 

You are informed that hereafter there must appear on the face 
of each voucher for services or articles purchased under authority 
contained in paragraph 649, Regulations of the Service, a brief but 
complete statement as to the conditions which necessitated imme- 
diate purchase without special authority from the bureau. 

The above order does not apply in case of vouchers rendered in 
favor of local apothecaries for medicines furnished seamen at third 
and fourth class stations. 

Rupert Blue, Surgeon General. 



Authority to be Cited on Bills for Medicines Furnished by Apothecaries. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, December 27, 1913. 

Bureau Circular Letter No. 26. 

To acting assistant surgeons, United States Public Health Service, 

and customs officers: 

You are informed that hereafter vouchers rendered in favor of 
local apothecaries for medicines furnished seamen at third-class 
stations should cite paragraphs 468 and 649, Regulations as authority 
for the expenditures. At stations in charge of customs officers, the 
authority cited on such bills should be paragraphs 649 and 660, Regu- 
lations of the Service. 

Rupert Blue, Surgeon General. 



17 

Relative to Transmittal of Requisitions for Medical Supplies. 

Treasury Department, 
Bureau of the Public Health Service, 

W ashington, January 3, 191Ii,. 

Bureau Circular Letter No. 27. 

To medical officers in charge^ United States Public Health Service: 

You are directed when forwarding the semiannual requisition for 
medical and other supplies, to give a complete inventory, in the 
column of articles on hand, of all medical and surgical supplies in 
the hospital dispensary and the storeroom. Articles should be care- 
fully inspected at the time the inventory is made, and all that are 
found worthless, if expendable, should be destroyed. 

The semiannual requisition should be made sufficiently early to 
reach the Purveying Depot by the 1st of April or the 1st of October. 
All requisitions, whether in letter form or on blanks, should be 
made in duplicate. 

Rupert Blue, Surgeon General. 



Transmitting Amendments to Service Regulations. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington^ February 16, 191j^. 

Bureau Circular Letter No. 28. 

Medical officers, United States Public Health Service, and others 

concerned: 

Your attention is called to the inclosed amendments (No. 1) to 
the Regulations of the United States Public Health Service, and you 
are directed to paste the same in your personal copy of the service 
regulations, and also in the copy, if any, belonging to your station. 

It is desired that you advise the bureau of your compliance with 
these instructions, and if you need any additional copies of these 
amendments, you should make request for the same. 

It is the intention of the bureau that every medical officer of the 
service be in possession of a copy of the service regulations and all 
amendments thereto. If you have not already received a copy of 
this volume, you are directed to so inform the bureau. 

Rupert Blue, 
Surgeon General. 

Inclosure. 

14330°— 21 2 



18 

Reports of Epidemics or of Unusual Prevalence of Disease. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, March 4, 1914. 

Barean Circalar Letter No. 29. 

To medical officers, United States Public Service: 

Your attention is invited to paragraphs 745 and 746 of the Regu- 
lations for the Government of the United States Public Health 
Service promulgated March 4, 1913, and you are directed to familiar- 
ize yourself vs^ith, and diligently observe, the provisions thereof. 

The duty of officers imposed by these paragraphs is one of the 
greatest importance to the bureau and to State and local health au- 
thorities throughout the country who look to the service and the Pub- 
lic Health Reports for current information regarding the occurrence 
of epidemics and the prevalence of disease. 

Reports forv^arded by letter in accordance with paragraphs 745 
and 746 should be briefed as follows: If the letter reports several 
diseases, the brief should read "Morbidity report." If the letter 
reports one or two diseases only, then the brief should also contain 
the names of the diseases being reported as, "Morbidity report — 
poliomyelitis and diphtheria," or " Morbidity report — epidemic 
cerebrospinal meningitis." 

Pursuant to paragraph 675 of the regulations letters making re- 
ports under paragraphs 745 and 746 above referred to should not 
include any subject other than that of the morbidity report. 

You are requested to acknowledge the receipt of this letter. 
Respectfully, 

Rupert Blue, 
Surgeon General. 

Relative to Reimbursement for Cost of Expensive Medicines and Ambulance 
Service in the Care of Foreign Seamen. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, March 17, 1914. 

Bureau Circular Letter No. 30. 

To tnedical officers, United States Puhlic Health Service: 

You are informed that if expensive medicines, such as neosalvarsan, 
argyrol, serums, vaccines, etc., are employed in the treatment of for- 
eign seamen or officers and enlisted men of the Army and Navy, a 
charge covering the cost of same should be made on the bill rendered 
for their care at contract stations or marine hospitals^ 



19 

Where there is no ambulance, a charge for ambulance hire should 
be added to the bill if an ambulance is used to convey the patient to 
the hospital. 

Rupert Blue, 

Surgeon General. 



Relative to Treatment of Cases of Amoebic Dysentery. 

Teeasuky Department, 
Bureau of the Public Health Service, 

Washington, March ^^, WH. 

Bureau Circular Letter No. 31. 

To medical officers in charge, United States Public Health Service: 

Reports have been received from a number of officers of the serv- 
ice of the successful treatment of amoebic dysentery by the use of 
emetine hydrochloride, either hypodermically or intravenously. Pri- 
vate physicians have also found this remedy of great value in this 
disease. The bureau wishes to encourage its use by all officers of the 
service. Requisitions may be sent to the Purveying Depot, or, in case 
of emergency, the drug may be purchased at the station under para- 
graph 649 of the regulations. It is sold in boxes containing 6 
ampules, each holding one-third of a grain of emetine hydrochloride 
dissolved in salt solution. 

You are requested to forward to the bureau a statement showing 
the number of cases of bacillary and emoebic dysentery that have re- 
ceived treatment at your station during the last five years. A report 
is also desired of any cases where emetine hydrochloride has been 
used, or of any cases so treated in future, together with your opin- 
ion of its value. 

Rupert Blue, 
Surgeon General, 

Data and Suggestions Relative Telegraphic Cipher Code. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, March 28, 19H. 

Bureau Circular Letter No. 32. 

To commissioned medical officers. Public Health Service: 

You are directed to review the files of telegrams received and sent 
from your station during the past three years and to excerpt the 
phrases most often used therein. These should be forwarded to the 
bureau without delay together with any suggestions which you be- 
lieve would be of value to the board for the revision of the tele- 
graphic cipher code of the service, 

Rupert Blue, 

Surgeon General. 



20 

Requesting Information as to Officers and Seamen of the United States 
Revenue- Cutter Service Treated for Venereal Diseases During 1913. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, April 2, 1914-. 

Bureau Circular Letter No. 33. 

To medical oncers of the United States Public Health Service: 

You are requested to forward a statement to the bureau of the 
number of officers and seamen of the United States Revenue-Cutter 
Service treated for venereal diseases at your station during the fiscal 
year 1913, both at the hospital and the out-patient office. 

The statement should give the permit number, name of patient, 
dates of admission and discharge if treated in hospital, or dates of 
office treatment, and condition when discharged. 

EuPERT Blue, 

Surgeon General. 



Information and Instructions Respecting Purchases, Contracts, Proposals, 

and Vouchers. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, April 11, 191 4-. 

Bureau Circular L«tter No. 34. 

To medical officers of the United States Public Health Service: 

The following information and instructions are published for the 
guidance of officers of the Public Health Service : 

Section 3709 of the Revised Statutes contains the following provi- 
sions : 

All purchases and contracts for supplies or services, in any of the departments 
of the Government, except for personal services, shall be made by advertising 
a sufficient time previously for proposals respecting the same, vp^hen the public 
exigencies do not require the immediate delivery of the articles, or performance 
of the service. When immediate delivery or performance is required by the 
public exigency the articles or services required may be procured by open pur- 
chase or contract at the place and in tie manner in which such articles are 
usually bought and sold, or such services engaged, between Individuals. 

Attention is called to the plain and positive language of the statute, 
which forbids the making of purchases and contracts without previ- 
ous advertisement in any other cases than those expressly excepted. 

The object of the law is to secure to the Government the advantages 
of competition in making contracts. All persons employed in the 
Public Health Service are expected to observe the letter and spirit 
of the law, and in inviting proposals to make bona fide efforts to 
induce competition. 



21 

The Comptroller of the Treasury has used the following lant^uage 
respecting the meaning of " advertising " as prescribed by the statute : 

To meet the requirements of section 3709, Revised Statutes, an advertisement 
need not necessarily be by publication in the newspapers, but by circulars sent 
to persons engaged in the particular business to be performed, or in furnishing 
the supplies desired, accompanied by posting of handbills in the proper. localities, 
or by other means of giving publicity. 

The publication of advertisements in newspapers will hereafter be 
authorized only when there are special reasons for such a course, and 
authority therefor must always be obtained beforehand. Section 3828 
of the Revised Statutes forbids the payment of bills for newspaper 
advertising that has not been previously authorized in writing by the 
head of the department. 

You are therefore directed, whenever proposals for supplies or 
repairs are to be obtained for the use of the Public Health Service., 
unless newspaper advertisement is authorized, to advertise for them 
by means of circular letters addressed to persons dealing in the sup- 
plies or engaged in doing the kind of work needed, and notices posted 
in public places. The circular letters and notices should be drawn in 
similar language, and copies of both should be forwarded to the 
bureau with the proposals. 

The lobby of the post office is regarded as a suitable place for the 
display of posters ; but they may be displayed in other places as well, 
and should be, if greater publicity can thus be insured. 

With regard to circular letters, the fact that the object of advertise- 
ment is to induce competition should be borne in mind, and the letters 
should be sent to a sufficient number of persons to insure such a result. 

Advertisement must be made early enough to allow dealers and 
others convenient time to make inquiries and prepare and deliver 
their proposals. The length of time that is sufficient will, of course, 
vary with circumstances. There may be occasions when one day will 
be sufficient; but, in general, unless the proposals are to be accepted 
by the station officer without previous bureau authority, not less than 
five days should be allowed ; and when the specifications are such as 
to make necessary numerous inquiries and calculations a longer time 
should be given. 

Specifications should be as plain as they can be made. Whenever 
it is possible, in schedules of supplies, the articles should be fully 
described and the specifications should contain in themselves all the 
information that dealers will need to be able to bid with under- 
standing. 

Articles may be described by trade names, provided the words " or 
equal " are written after the description. In such case dealers should 
be made to understand that the articles offered at the lowest prices 



22 

will be purchased, if they are satisfactory, even though they are not 
of the same make. If articles offered under such conditions are not 
satisfactory for the purpose, a detailed explanatory statement to that 
effect must be made in the letter of transmittal. 

When proposals are forwarded to the bureau they must be accom- 
panied with the form letter of transmittal provided for the purpose. 

When a schedule of supplies contains numerous items, and it is 
recommended that some of the articles be purchased from one bidder 
and some from another, a comparative schedule of the proposals must 
be furnished, so that the several bids may be readily compared and 
the correctness of the figures given in the recommendations verified. 
Comparative schedules should be made out in the following manner 
(see par. 8, form letter of transmittal) : 

Let it be supposed that there are three proposals for a lot of sup- 
plies embraced in one schedule ; that each of three bidders, A, B, and 
C, is lowest on some items ; and that it is recommended that from each 
be purchased the articles for which he has made the lowest bid. Make 
first a list of the articles for which A is the lowest bidder, and give, in 
separate columns, the prices of all three bidders. Thus : 



Articles. 


A. 


B. 


C. 


3 carpets 


$90.00 
15.00 
21.00 
8.00 


J108.00 

16.50 

24.00 

9.60 


$93.00 




18.00 


2 desks.. 


23.00 




8 40 






Total 


134.00 


158. 10 


142.40 







Then make a similar list of the articles for which B is the lowest 
bidder, and so on. 

When notice of the approval of a proposal or contract is received 
at the station, the bidder or contractor should be informed at once 
by letter. 

EXIGENCY PURCHASES. 

No purchase the necessity for which should have been foreseen and 
provided for is an exigency purchase within the meaning of para- 
graphs 649 and 650 of the Regulations. The cases enumerated in 
paragraph 650 are given as examples for cases where a public exi- 
gency may make necessary an expenditure without special authority ; 
but if the necessity for an expenditure is foreseen, no matter what the 
object of the expenditure may be, application should be made to the 
bureau for authority therefor. The rule applies even in cases where 
it is certain that competitive proposals for the articles or service can 
not be obtained. 



^3f 

METHODS TO BE FOI-LOWED IN MAKING PtIRCHASES UNDEE ATTTHOBITY CONTAINED- 
IN PAKAGEAPH 649, EEGULATIONS OF THE SERVICE. 

1. When the necessity for an article or service iis not so urgent as to prevent 
the purchase thereof under proposals received after advertising by poster and 
circular letter, you are directed to follow this procedure in making such pur- 
chases. The lowest or most advantageous proposal received should be accepted, 
the article or service ordered from the successful bidder, and all proposals re- 
ceived forwarded to the bureau with the voucher rendered for the expenditure 
incurred. If one of the higher proposals received is accepted, the reasons for 
such action should be clearly set forth in a letter of transmittal. 

2. When the necessity for an article or service is so urgent as to preclude 
advertising by means of poster and circular letter, but, nevertheless, there is 
time available for direct personal solicitation of competition, you are directed 
to solicit competition by means of the telephone, personal visit, or otherwise. 
Each proposal thus secured shall be confirmed in writing and the written con- 
firmation treated as a proposal. As mentioned in the preceding paragraph, the 
lowest or most advantageous proposal received shall be accepted, the order 
placed with the successful bidder, and all proposals- forwarded to the bureau 
with the voucher rendered for the expenditure incurred. If one of the higher 
proposals received is accepted, the reasons for so doing should be given in a 
letter of transmittal. 

3. When the necessity for an article or service is so urgent that there is no 
time available in which to obtain competition by either of the methods men- 
tioned in the two preceding paragraphs, the article or services required may be 
procured by open purchase or contract in the manner in which such articles are 
usually bought and sold, or such services engaged, between individuals. On 
the face of vouchers for expenditures incurred in this manner, or without com- 
petil^ion, the reason why it was not practicable to obtain competition should be 
given. 

4. Paragraph 649, Regulations of the Service, should be cited as authority 
on all vouchers incurred in the manner prescribed in the three preceding para- 
graphs. There should also be given on the face of these vouchers the reasons 
which necessitated incurring the expenditure under exigency, i. e., without pre- 
vious authority from the bureau. 

STATIONERY. 

Eequisitions for stationery supplies, Form 2162, shall be forwarded 
to the bureau on April 1 of each year and shall include a year's sup- 
ply of each item required. Supplementary requisitions on Form 
2163 shall be forwarded when additional supplies are necessary. 
Exigency purchases not to exceed $5 may be made for stationery sup- 
plies when the articles are necessary for immediate use and the service 
should be embarrassed if the supplies were not obtained at once. 
Such exigency purchases of stationery shall be made by one of the 
three methods outlined above. 



24 

VOTTOHEES FOE EXIGENCY PURCHASES. 

The importance of strict compliance with the foregoing require- 
ments with respect to purchases under exigency is best ilkistrated by 
the following incident : 

The disbursing clerk of the Treasury Department recently re- 
quested a decision of the Comptroller of the Treasury as to whether 
he had authority to pay a bill for two dozen hemmed napkins, $6.24, 
and one hand bell, 85 cents, which were purchased by an officer of the 
service as an emergency. The decision of the comptroller, dated 
March 31, 1914, states that " it was the duty of the surgeon in charge 
of the marine hospital to advertise for proposals to furnish tke sup- 
plies in question, in one of the two methods set forth by regulations," 
and further, that " the mere statement that an emergency existed for 
the purchase of the articles is by no means conclusive upon the ques- 
tion. An exigency or emergency justifying such a purchase must be 
not the creature of some one's imagination but a condition predicated 
upon facts." 

Paragraph 649 of the regulations prescribes that in all bills con- 
tracted without special authority the nature of the exigency shall be 
stated in full on the face of the voucher. This means that the facts 
constituting the exigency shall be stated. A certificate to the effect 
that the articles or services were " immediately necessary," or that a 
"public exigency required the immediate delivery or performance" 
is not sufficient. Such a certificate states merely a conclusion drawn 
from facts instead of the facts themselves. In short, the statement 
must show, not merely state, that the expenditure was immediately 
necessary and must show why the necessity was not foreseen and 
provided for. 

Another recent decision of the Comptroller of the Treasury directs 
that payment of an exigency voucher that does not bear on its face a 
statement explaining why the necessity could not have been foreseen 
by ordinary care shall be refused. Accordingly hereafter every such 
incomplete voucher will be returned to the officer who rendered it, 
and in default of a satisfactory explanation it can not be paid. 

Whenever it is possible such bills should be itemized and unit 
prices should be given, as well as any other information necessary to 
enable the bureau to judge of the reasonableness of the bill. 

EuPERT Blue, 
Surgeon General, 



25 

Relative to Forwarding Estimates of Repairs and New Construction of 

Buildings. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ April 11^ 19 Uf. 

Bureau Circular Letter No. 35. 

To 'medical officers in charge United States marine hospitals and 

quarantine stations: 

You are informed that the department has advised the bureau that 
arrangements will be made to have a yearly inspection made of marine 
hospitals and quarantine stations by technically qualified inspectors 
of the Supervising Architect's Office for the purpose of ascertaining 
the conditions and the necessity for major repairs. 

It is intended to make the first inspection during the months of 
May and June of this year and to repeat such inspections in the fol- 
lowing years at about the same time. 

The first inspection will be for the purpose not only of getting data 
for repairs, but also of obtaining reliable data, which are now missing, 
regarding the topography of the stations, the number of buildings 
located thereon, breakwaters, bulkheads, wharves, etc., and their gen- 
eral condition, supplemented by bird's-eye photographs of the differ- 
ent buildings or groups of buildings. Copies of these will be sup- 
plied to the Public Health Service. 

It- is the opinion of the department that one yearly inspection should 
be sufficient for the purpose, and that it will not be necessary for the 
custodians to call for intermediate inspections regarding minor re- 
pairs, etc. 

The annual detailed estimate of amounts required for ordinary re- 
pairs and the annual detailed estimate of amounts necessary for new 
construction should be forwarded to the bureau on May 1 instead of 
July 1, as has previously been the custom, in order that the inspectors 
may have these reports in hand when they inspect the stations. 

Rupert Blue, 
Surgeon General. 



Marine Hospitals and Quarantine Stations Made Available for Care of Sick 
and Wounded of the Army and Navy. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ April 25, 1911^. 

Bureau Circular Letter No. 36. 

To medical officers of the Puhlic Health Service: 

The United States marine hospitals and quarantine stations are 
hereby made available for the reception of the sick and wounded of 



^6 

either the United States Army or the United States Navy, and you 
are hereby directed upon written request of the proper military or 
naval authority to receive and care for said patients, the service to 
be reimbursed the actual cost of maintenance. 

Rupert Blue, 
/Surgeon General. 
Approved : 

W. G. McAdoo, Secretary, 
The White House, 
Approved : 

WooDROw Wilson. 
April 27, 1914. 

Reports of the Prevalence of Disease. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, April 28, 1914.. 

Bureau Circular Letter No. 37, 

To medical officers of the United States Public Health Service : 

With reference to the weekly reports which medical officers have 
been forwarding of the prevalence of disease in the localities in which 
they are stationed, you are informed that the health departments of 
most of the important cities of the United States forward each week 
to the Surgeon General a morbidity report on blank Form 8960 fur- 
nished by this service, of which a copy is inclosed. 

Where the city health department is forwarding these reports, du- 
plicate reports obtained from the same source and containing the 
same information are unnecessary and are not desired. (This does 
not apply to the telgraphic reports of epidemics and of unusual dis- 
ease conditions required by paragraph 7i5 of the regulations.) 

The cities which report direct to the bureau are those which appear 
each week in the Public Health Reports in the table for diphtheria, 
measles, scarlet fever, and tuberculosis. If the city in which you are 
stationed does not appear in this list and the enforcement of the noti- 
fication of the communicable diseases is such that the information 
available at the health department shows the prevalence of these dis- 
eases, you are directed, if you are the ranking service officer on duty 
in the city, to secure from said health department each week the nec- 
essary information and forward to the bureau a report on Form 8960, 
a supply of which will be furnished to you upon request. 
Respectfully, 

Rupert Blue, 

Surgeo7i General. 

1 inclosure. 



27 

Rate of Charge for Soldiers and Seamen Admitted to Marine Hospitals. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, April 30, 1911^. 

Bureau Circular Letter No. 38. 

To medical officers in charge. United States marine hospitals and 
quarantine stations: 

The rate of charge for soldiers and seamen admitted to United 
States marine hospitals and quarantine stations under the provisions 
of Bureau Circular Letter No. 36, dated April 25, 1914, is hereby 
fixed at a uniform rate of 75 cents per diem. 

Eupert Blue, 

Surgeon General. 
Approved : 

B. P. Nevi^ton, 

Assistant Secretary. 



Method of Treatment and Certification of Freight in Foreign Ports Destined 

to United States Ports. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, May 16, 19H.. 

Bureau Circular Letter No. 39. 

To officers of the United States Public Health Service, consular 

officers, and others concerned: 

The object of this circular is to facilitate the interpretation of 
certain paragraphs in the United States Quarantine Regulations re- 
lating to the certification of freight in foreign ports when destined 
for United States ports, and to aid consular officers and medical offi- 
cers of the United States Public Health Service, when assigned to 
duty in United States consulates in foreign countries, in deciding 
upon the treatment to be accorded in individual cases. 

PARAGRAPHS OF THE QUARANTINE REGULATIONS RELATIVE TO THE CERTI- 
FICATION OF FREIGHT. 

(«) Paragraph 13, page 22: 

Bedding, upholstered furniture, soiled wearing apparel, personal effects, and 
second-hand articles of a similar nature, coming from a district known to be 
infected with cholera, smallpox, typhus fever, or as to the origin of which no 
positive evidence can be obtained, and which the consular or medical ofllcer has 
reason to believe are infected, should be disinfected prior to shipment. In the 
case of typhus fever the destruction of vermin should be assured. Articles 
similar to the above mentioned, if from a district infected by plague, should 
be inspected, and, if necessary, disinfected and treated to destroy vermin. 



28 

{h) Paragraph 14, page 22: 

Articles from an uninfected district shipped through an infected port may be 
accepted without restriction if not exposed to infection in transit. 

(c) Paragraph 17, page 22 : 

Any article presumably infected, which can not be disinfected, should not be 
shipped. 

{d) Paragraph 27, page 25 : 

Certain food products, viz, unsalted meats, sausages, dressed poultry, fresh 
butter, fresh milk (unsterilized), fresh cheese, coming from cholera-infected 
localities or through such localities, if exposed to infection therein, should not 
be shipped. Fresh fruits and vegetables from districts where cholera prevails 
shall be shipped only under such sanitary supervision as will enable tlie inspector 
to certify that they have not been exposed to infection. 

{e) Paragraph 28, page 25: 

All rags and textile fabrics used in the manufacture of paper and for other 
purposes which are collected, packed, or handled in any foreign port or place, 
with the exceptions as hereinafter specilaed, shall, prior to shipment to the 
United States, be subjected to disinfection by one of the prescribed methods. 
(Jute bags or bagging used in baling cotton, old rope, new cotton, or linen cut- 
tings from factories not included.) The disinfection of the articles mentioned 
above shall be performed under the supervision of a United States consul or a 
medical officer of the United States, and a certificate in duplicate, signed by said 
consul or medical officer, shall be issued with each consignment of same, which 
certificate shall identify the articles and state that they have been disinfected 
in accordance with the United States Quarantine Regulations. The original 
certificate of disinfection shall be attached to the consignee's invoice, and 
where the articles are carried by sea the duplicate certificate of disinfection 
shall be attached to the bill of health issued to the vessel conveying the same. 

Exceptions. — Such articles shipped from the Dominion of Canada directly to 
the United States shall be exempt from this requirement if accompanied by affi- 
davits demonstrating to the satisfaction of the collector of customs at the port 
of arrival that they have actually originated in Canada and have not been 
shipped from a foreign country to Canada, and thence shipped to the United 
States ; and, further, that the port or place where collected or handled has been 
free from quarantinable disease for 30 days prior to shipment. 

(/) Paragraph 39, page 27 : 

Articles which harbor or are liable to harbor rats or rat fleas should not be 
shipped until freed of such vermin, either by the use of chemicals, fumigation, 
or solutions, or by preventing the access of rats for 15 days before shipment. 
The nature of the merchandise and the place and method of stowing prior to 
shipment must be considered in determining its liability to be a rat or vermin 
carrier, thus : Bundles of hides, bags of grain, etc., so stowed as to be used as 
nesting places for rats would be flea, and might be rat, carriers. 

When the cargo of a vessel consists of grain or other rat food, extra precau- 
tions should be taken to prevent rats from going aboard. 

Hides, chemically cured, are not liable to harbor rats or rat fleas ; and loose, 
single hides are less liable to do so than when baled. 



29 

OERTiriCATlON OF FREIGHT FROM LOCALITIES INFECTED OK SUSPECTED OF 
BEING INFECTED WITH PLAGUE. 

1. In the case of vessels which have been rendered rat free by fumi- 
gation just prior to receiving cargo the following cargo may be 
loaded without treatment: 

a. Filled rat-proof containers, such as kegs, barrels, cans, boxes, or 
cases. 

b. Moist or green and dry hides, if the bundles are opened to in- 
spection to determine freedom from rats. 

Note. — Paragraph 15, page 22, of the Quarantine Regulations should inva- 
riably be borne in mind in connection with the certification of hides, and par- 
ticular attention should be given to any other regulations as to the importation 
of live animals. 

" Paragraph 15 : Nothing in these regulations shall be construed to modify or 
affect in any way any existing restrictions promulgated by the Secretary of the 
Treasury, at the instance of the Secretary of Agriculture, regarding the importa- 
tion of hides of neat cattle." 

c. Upholstered furniture, general personal effects, and second-hand 
articles, curios, feathers, mattresses, matting, wool and furs, crated 
bamboo ware, plants, bulbs and seeds, rope, cuttings, bones, tendons, 
bone meal, hides, horns, hoofs, hair, bristles, etc., if it can be deter- 
mined that the articles and their containers are rat free. 

Note. — If the consular or medical officer is unable to make arrangements for 
determining whether the articles are rat free, then two courses of action are 
open. ^ One is to have the freight fumigated for the destruction of rats, and the 
other is to recommend against the shipment of the freight and make a special 
report of the incident for the quarantine officer at the United States port of 
arrival. 

2. In the case of vessels which have not been rendered rat free by 
fumigation just prior to receiving cargo the following cargo may be 
loaded without treatment : 

Filled rat-proof containers, such as kegs, barrels, boxes, or cases. 

Note. — In case cargo not coming within this classification is shipped the offi- 
cer issuing the bill of health should notify the quarantine officer at the port of 
destination, so that he may, in his discretion, require fumigation of the vessel 
to kill rats prior to removal of cargo or inspections of the cargo to determine its 
freedom from rats, 

FUMIGATION OF CARGO. 

The fumigation of cargo incapable of being injured by sulphur gas 
should be carried out by exposure for 6 to 12 hours, according to the 
character of the freight, to sulphur dioxide gas 4 per cent. Freight 
which would be injured by sulphur gas may be treated, if practicable. 



30 

by hydrocyanic gas (see par. 188, United States Quarantine Regu- 
lations), but extreme care is necessary to guard against danger to 
human life. 

CARGO WHICH CAN NOT BE DISINFECTED. 

Paragraph 17 : Any article presumably infected which can not be disinfected 
should not be S'hipped. 

CARGO TO BE PROHIBITED SHIPMENT FROM PLAGUE-INFECTED OR PLAGUE- 
SUSPECTED PORTS. 

Fruits and vegetables, especially potatoes and onions, unless packed 
in tight boxes or containers, or else in crates protected by ^-inch wire 
mesh. 

MISCELLANEOUS FREIGHT NOT COVERED IN ABOVE CLASSIFICATION. 

Human hair, if treated by immersion in kerosene oil, may be passed, 
also human hair arranged in hanks and packed so that it will not 
harbor rats or fleas. Hair other than human, bristles and feathers, 
should be immersed in kerosene oil if originating in infected or sus- 
pected localities. Soiled wearing apparel should invariably be boiled, 
steamed, or exposed to formaldehyde gas in an air-tight compart- 
ment. If formaldehyde be used, follow directions in either para- 
graph 165 or 166, page 48, of the United States Quarantine Regula- 
tions. 

FREIGHT FROM CHOLERA-INFECTED PORTS. 

Certification of freight with regard to cholera depends solely upon 
whether it contains foodstuffs which may have become infected in the 
process of packing. In the event there is doubt as to whether such 
articles are liable to convey the infection of cholera, they are not to 
be subjected to any process of fumigation, but are simply to be re- 
jected and the facts reported to the quarantine officer at the port of 
arrival, in the event shipment is made despite the rejection of the 
freight. Unsalted meats, sausages, dressed poultry, fresh butter, 
fresh milk (unsterilized), fresh cheese, fresh fruits and vegetables, 
and the like should not be shipped from cholera-infected localities. 

RAGS. 

Ea<gs should be considered separately from old gunnies, bags, ropes, 
etc. The latter should be considered from the standpoint of their 
liability to harbor rats and fleas. Rags are especially covered by the 
regulations (see par. 28, p. 25, U. S. Quarantine Regulations) and 



31 

should be disinfected by steam under pressure, or else by one of the 
recognized processes for the preliminary treatment of rags, as fol- 
lows : 

1. The rags are placed in a brick oven and subjected to sufficient 
heat to dry them out thoroughly. Then a spray of hydrochloric acid 
is passed through them for a period of one hour, or until every fiber 
of cotton is absolutely penetrated. The spray is then turned off, and 
the rags are again subjected to heat until they are absolutely dry 
again. They are then taken to a shaker into which heat is injected! 
and thoroughly dusted out. They are then taken to a large vat andi 
thoroughly washed with clean water to neutralize the effect of the: 
acid. A modification of this method, also acceptable, may be de- 
scribed as follows: 

2. The rags are first dried until they are absolutely free from mois- 
ture, and then they are placed in a revolving cylinder and again sub- 
jected to the drying heat. They are then treated with muriatic-acid 
fumes until all vegetable matter is destroyed. They are then well 
shaken out to remove the carbonized vegetable dust, and afterwards 
washed in clean water to neutralize the acid, and finally dried. 

3. The rags are boiled, with or without soda solution. They are 
then dried and packed in tight bales. 

EGGS. 

Eggs packed in rice-straw ashes with a considerable percentage of 
table salt may be certified without reservation. Hides, horns, hoofs, 
etc., may be passed if certified to be free from rats. 

FORM or CERTIFICATE TO BE USED BY UNITED STATES CONSULAR OFFICERS 
AND, WHEN PRACTICABLE, TO BE COUNTERSIGNED BY MEDICAL OFFICERS 
OF THE UNITED STATES PUBLIC HEALTH SERVICE. 

CERTIFICATE OF DISINFECTION OR OF NONINFECTION, 

No. American Consulate , 



19- 



I, the undersigned , of the United States of America, at , 

do hereby certify that the goods, wares, merchandise, animals, or articles or 

commodities described in consular invoice No. , dated , and issued by 

this consulate , have been fumigated, disinfected, or otherv?ise treated, or 

exist in the condition specified below, therein meeting the requirements of the 
quarantine regulations of the United States of 1910, and other instructions as 
noted, to wit: 

(Specimen or sample entries.) 

22 bales (mark 1-22) moist hides; inspected; rat free. 

6 cases human hair (mark J, P. S. 1-6), Immersed in kerosene oil. 



32 

400 bags bonemeal (mark P. M. S. 1-400). Stored 60 days in premises free 
from plague infection. 
Countersigned : . 



Surgeon, U. S. P. H. S. 

In witness whereof I hereunto set my hand and seal of the consulate 

of the United States at , this day of , 191—. 

[seal.] 

Fee, $ -. Consul 

Rupert Blub, 

Surgeon General. 

Annual Reports. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, May 21, 1914,. 

Bureau Circular Letter No. 40. 

To commissioned medical officers, acting assistant surgeons, and 

others concerned: 

It is hereby directed that annual reports of transactions for the 
fiscal year ending June 30, 1914, shall be forwarded to the bureau 
from all stations immediatelj^ after July 1. It is essential that these 
reports be received in the bureau by August 1, 1914, and failure to 
receive sanie from any station by that date will necessitate an ex- 
planation on the part of the responsible officer. 

Rupert Blue, 
Surgeon General. 



Relative to Expendable Property. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, May 27, 191^. 

Bureau Circular Letter No. 41. 

To medical officers, TJ. S. Puhlic Health Service: 

You are hereby authorized to treat as expendable property the 
following-named articles, in accordance with paragraph 582, service 
regulations : 

Welsbach burners, Section lifters, 

Incandescent lamps, Bottle brushes, 

Stender dishes, Tooth brushes, 

Bottles, glass stoppered, Capillary tubes, 

Test tube brushes, Graduated blood counting tubes foi 

Rubber corks, centrifuge, 

Bone splints. Centrifuge sediment tubes. 

Centrifuge tubes, Needles, hermotomy. 



33 



Needles, intestinal, 

Indelible ink outfit, 

Finger cots, 

Filiform bougies, 

Needles, suture. 

Drooping bottles. 

Fermentation tubes, 

Bell jars, 

Pipettes, 

Slide boxes. 

Staining jars. 

Bottles, balsam. 

Bottles, staining, 

Bottles, oil, immersion. 

Wire gauze, brass, 

Test tube cleaners, 

Tent pins, 

Atomizer bulbs, 

Hose for gas range or stove, 

Pinch cocks, 

Ink pads, 

Droplight sliades, 

Needles, necropsy, 

Apochromatic plates, 

Drainage tubes, bone, 

Flower pots, 

Eclipse plates, 

Stop cocks, 

Irrigator spout caps, 

Beakei*s, glass. 

Splints, basswood, 



Rubber cocks. 

Hones for steel erasers, 

Feeding tubes. 

Glass nozzles. 

Glass eye baths. 

Scythe stones. 

Whalebone bougies. 

Goggles, 

Rifle stones. 

Stencil plates. 

Fly killers. 

Urine percentage tubes. 

Needles, spinal, 

Haemoglobinometer scales, 

Wide mouth bottles, 

Reagent bottles, 

Porous splints. 

Glass drainage tubes. 

Sputum needles. 

Connecting pieces, glass, 

Flue brushes. 

Needles, Mayo's, 

Needles, Emmet's, 

Recto-colonic tubes. 

Lamp shades, 

Spitcup holders. 

Iodoform dusters. 

Rubber spout cups, 

Rubber funnels. 

Rubber gloves, 



Rupert Blue, 

Surgeon General. 



Relative to Attaching to Property Returns Lists of Nonexpendable Articles 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, June 2, 1914-. 

Bureau Circular Letter No. 42. 

To medical officers, United States Public Health Service: 

You are hereby directed to attach to the property returns certified 
lists of the nonexpendable articles in vouchers for purchases charge- 
able to the appropriations under the control of the Supervising Ar- 
chitect, instead of attaching the lists to the vouchers as directed in 
bureau letter of June 8, 1907. 

Also attach to the property returns certified lists of the nonex- 
pendable articles on invoices of stationery furnished on requisitions. 

KuPERT Blue, 
Surgeon General. 
14330°— 21 3 



34 

Registration of Births and Deaths on Government Reservations. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, June 8, IQlJf. 

Bureau Circular Letter No. 43. 

To medical and other officers, United States Public Health Service: 

You are directed to pay particular attention to compliance with 
local laws and regulations regarding the registration of births and 
deaths. You are directed further to see that these laws are complied 
with by all persons living on any reservation under your charge. 

In localities where there is no requirement for the registration of 
births or deaths these shall be reported to the Surgeon General upon 
the standard birth and death certificates, copies of which will be fur- 
nished by the bureau upon request. 
Respectfully, 

Rupert Blue, 
Surgeon General. 



Prompt Rendering of Traveling Expense Vouchers. 

Treasury Department, 
Bureau of the Pitblic Health Service. 

Washington, D. C, July 8, 19H. 

Bureau Circular Letter No. 44. 

To officers and other einfloyees, United States Public Health Service: 

In order to close the accounts of appropriations for the fiscal year 
ended June 30, 1914, you are instructed to forward to the bureau 
without delay any pending bills for traveling expenses incurred dur- 
ing the last fiscal year. 

Hereafter vouchers for reimbursement of traveling expenses must 
be promptly forwarded at the termination of each trip or, if the 
detail extends over a considerable period of time, immediately at 
the end of each month. 

The memorandum copy of transportation request should be re- 
turned to the bureau either immediately after the purchase of trans- 
portation or upon completion of the journey, if delay is necessary 
to complete the routing. The cost of transportation and of Pullman 
accommodation must be ascertained when purchased and the amount 
placed on memorandum copy. 

Bureau approval of vouchers for reimbursement of traveling ex- 
penses will be withheld, unless the above directions are complied 
with, pending the receipt of the memorandum copy or of an explana- 
tion regarding delay in submitting vouchers. 

A. H, Glennon, 
Acting Surgeon General. 



35 

Glinical Records of Patients Recommended for Transfer to Fort Stanton. 

Treastjkt Department, 

BuKEAU OF THE PuBLIC HeALTH SeRVICE, 

Washington^ July 8, 1914-. 

Bureau Circular Letter No. 45. 

To medical officers, Umted States Public Health Service: 

It is hereby directed that hereafter clinical records of patients 
recommended to the bureau for transfer to the United States Public 
Health Service Sanatorium at Fort Stanton, N. Mex., shall be pre- 
pared to show the following, viz : Family history ; past and present 
history ; condition of the lungs, heart, blood vessels, intestines, stom- 
ach, kidneys, liver, blood pressure ; stamped diagrams of the anterior 
and posterior views of the thorax (with marginal notes on the same) ; 
records of respiration, pulse rate, and temperature ; result of exami- 
nations of the blood, urine, and sputum; area and extent of tuber- 
cular involvement ; and general physical condition of the patient. 
Each clinical report should be typewritten. 

A. H. Glennan, 
Acting Surgeon General. 



Relative to Riglit of Relief of Bar Pilots and Fishiermen as Patients of the 
U. S. Public Health Service. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, July 15, 19H. 

Bureau Circular Letter No. 46. 

To commissioned medical officers and acting assistant surgeons, 
United States Public Health Service, and customs officers: 
The following decisions, rendered by the Comptroller of the Treas- 
ury, are included in his letters addressed to the honorable the Secre- 
tary of the Treasury, under dates of May 8 and 26, 1914, and are 
hereby made known for your information and guidance. 

Under date of May 8, 1914, the comptroller states in part, regard- 
ing the right of bar pilots to the benefits of the service, that — 

* * * the only persons entitled to treatment at Government expense in hos- 
pitals provided by the Public Health Service (with certain exceptions not here 
material) are "sick and disabled seamen employed in registered, enrolled, and 
licensed vessels of the United States." (Sec. 4803, R. S.) 

Section 3 of the act of March 3, 1875 (18 Stat, 485), provides: "That term 
seamen, whenever employed in legislation relating to the marine-hospital service 
(now Public Health Service), shall be held to include any person employed on 
board in the care, preservation, or navigation of any vessel, or in the service, 
on board, of those engaged in such care, preservation, or navigation." 

It will be observed that all seamen are not entitled to free treatment at 
Public Health Service hospitals, but only those employed in registered, enrolled. 



36 

or licensed vessels of the United States. And while the term " seamen," as 
above defined, might, and no doubt w^ould, include pilots, it does not follow that 
all pilots are entitled to the relief. If a pilot is regularly employed as a mem- 
ber of the crew or complement of a registered, enrolled, or licensed vessel of 
the United States, he would be entitled to the relief the same as otlier seamen 
so employed. But I do not understand that these bar pilots are thus employed. 

The pilot boats are used by them only as a means of reaching the vessels 
which they are to pilot in and of returning to the shore from vessels piloted 
out. While they may perform some duties on said pilot boats, such duties are 
merely incident to the travel between the outer stations and the shore stations. 
Their real duties, that is, the duties for which they receive compensation, are 
performed on the vessels which they pilot in or out. Therefore, they can not 
be said to be employed on the pilot boats. 

Neither are they employed on the piloted vessels. They are not members of 
the crew or complement of men of said vessels, and in piloting them in or out 
of the port they are acting not in the capacity of employees of the vessel but 
are rendering a special service compensated for by fees provided by city ordi- 
nance and are regarded rather as officers of the port. 

You are advised, therefore, that bar pilots, as such, are not entitled to relief 
furnished by the United States Public Health Service. 

In letter dated May 26, 1914, the comptroller states in part as 
follows relative to the right to the benefits of the service by persons 
carried on the rolls of fishing vessels as seamen, but whose services 
are not actually required in the care, preservation, or navigation of 
said vessels: 

* * * Such persons are not entitled to the benefits in question unless they 
are " seamen employed in registered, enrolled, or licensed vessels of the United 
States." (Sec. 4803, R. S.) 

Carrying a man on the rolls of a vessel as a seaman does not necessarily 
make him a seaman. To be regarded as a seaman within the meaning of the 
laws relating to the Public Health Service, a person must be " employed on 
board in the care, preservation, or navigation " of a vessel or be " in tlie service 
on board of those engaged in such care, preservation, or navigation." (Sec. 3, 
act of Mar. 3, 1875, 18 Stat, 485.) 

It appears from the evidence accompanying your submission that the real 
work for which these fishermen are employed, and for the performance of which 
they receive compensation, is to be performed not actually on board the vessel 
but in small boats. But I understand that these small boats constitute a part 
of the necessary equipment of the fishing vessel, and that the fishermen live on 
said vessels, except when actually on duty in the small boats, during the entire 
period of their employment. If such be the case, I am of the opinion that they 
must be regarded as in the service, on board, of persons engaged in the care, 
preservation, or navigation of the fishing vessel. And if said vessel is a regis- 
tered vessel of the United States, they are entitled to the benefits of the Public 
Health Service to the same extent and under the same conditions as are the 
members of the regular crew of the vessel. 

The question submitted is answered accordingly, 

A. H. Glennan, 
Acting Surgeon General. 



37 

Reports to Bureau to be Typewritten, Double Spaced, and Information 
Regarding Illustrations to be Given. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, July 31, 1914-. 

Burean Circular Letter No. 47. 

Medical officers^ United States Public Health Service, and others 
concerned : 

In making reports to the bureau you are directed, where possible, 
to have them typewritten and double spaced. 

Drawings submitted with reports should be stated to be originals, 
or, if copies, proper acknowledgment should be made of the source 
from which they were taken. Photographs submitted as illustra- 
tions should show whether they may be used, to whom they belong, 
by whom they were taken, and whether they may be kept by the 
bureau. Reports should be forwarded with a letter of transmittal. 
Respectfully, 

KuPERT Blue, 

Surgeon General. 



Standardization at Field Stations of Cards, Filing Equipment, Etc., in 
Accordance With Sizes Adopted in Washington. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, Septetnber 25, 1911^.. 

Barean Circular Letter No. 48. 

Medical officers and other employees, United States Public Health 

Service : 

By direction of the Secretary of the Treasury, you are hereby in- 
structed to conform to the following resolution recently adopted by 
the General Supply Committee: 

It is recommended that the Secretary of the Treasury request the heads of 
the several executive departments and independent Government establishments 
having field services, where work is conducted in conjunction with the Wash- 
ington offices which requires the use of cards, filing equipment, or other office 
equipment which has been standardized, to use in the field service the sizes 
upon which the Government has standardized in the Washington offices, as 
this is the only means by which confusion and embarrassment will be avoided. 

HuPERT Blue, 

Surgeon General. 



88 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, October 8, 19 H. 

Bnreaa Circular Letter No. 49. 

To ofjicers in charge of marine hospitals and relief stations: 

There is transmitted herewith a supply of blanks (Form 1922), 
copies of which are to be used hereafter in rendering monthly re- 
ports of relief furnished patients of the service. 

All other blanks on hand bearing the above number should be 
destroyed at once. 

A. H, Glennan, 
Acting Surgeon General. 



Relative to Claims for Exemption at the Source Under Income Tax Law. 

Treasury Department, 
Bureau of Public Health Service, 

Washington, October 19, WH. 

Bureau Circular Letter No. 50. 

Commissioned officers and others concerned, United States Public 

Health Service: 

There is inclosed herewith a copy of the law and regulations rela- 
tive to the income tax, together with a blank exemption certificate, 
which is to be completed and forwarded as soon as possible to the 
disbursing officer by whom payments of salary, including commu- 
tation of quarters, are made. 

Attention is called to paragraph C of the Federal income-tax law 
of October 3, 1913, on page 6 of the inclosed copy of the law. This 
claim for exemption in no wise affects the return to the collector of 
internal revenue required to be made by paragraph D of said act. 

The disbursing clerk of the Treasury Department will deduct the 
income tax from the salary and commutation checks of officers, due 
December 31, 1914, who are paid by him; in other cases deductions 
will be made by the special disbursing agent in your district. 

The income tax will not be retained at the source until the amount 
exceeds the exemption. When no deductions are made at the source 
on account of salary and commutation of quarters, full settlement 
must be made with the Collector of Internal Revenue, to whom 
return is made. 

Rupert Blue, 

Surgeon General. 



39 

Completion of Vouchers. 

Trbasuky Department, 
Bureau of the Public Health Service, 

Washington^ Deceinber 10, 19H. 

Bureau Circular Letter No. 51. 

Medical officers, United States Public Health Service, and others 

concerned: 

In many vouchers received at the bureau the paragraphs on the 
reverse, cited in the certificate on the face, are not completed. 

The statements on the reverse of the voucher are an essential part 
of it, and they should always be completed before the voucher is 
forwarded to the bureau, with the exception of (B), which should be 
left blank. 

When a written proposal has been accepted in writing by the officer 
in charge of the station the proposal and a copy of the notice of ac- 
ceptance must accompany the voucher. 

When the reference is to 4 under " Method or absence of advertis- 
ing," the reason why competition could not be obtained must be 
stated. 

When the reference is to (C) under "Form of agreement," the 
character of the agreement must be shown; for instance, whether it 
was oral, or whether it consisted of a written offer and an oral ac- 
ceptance. In the latter case the proposal must accompany the 
voucher. 

Rupert Blue, 

Surgeon General. 

Relative to Sick OflBcers of the Revenue- Cutter Service. 

Treasury Department, 
Bureau or the Public Health Service, 

IV ashing ton, Decerriber 2%, 19 IJ^. 

Bureau Circular Letter No. 52. 

To medical officers of the United States Public Health Service: 

Whenever it is necessary to give an officer of the Revenue- Cutter 
Service a certificate recommending leave of absence on account of 
sickness, for two weeks or more, you are directed to send a clinical 
report of his case, in duplicate, to the bureau, giving his symptoms 
and a statement of his physical condition, particular attention being 
given to the heart, lungs, kidneys, and organs of special sense. 

The Revenue- Cutter Service desires to have its sick officers treated 
at marine hospitals, and therefore no recommendation should be 



40 

made that they spend their leave at their homes, except under unusual 
circumstances. 

KuPEET Blue, 

Surgeon General. 



Directions for Transmission of Pathological Specimens to the Hygienic 

Laboratory. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ December 28, 1914.. 

Bureau Circular Letter No. 53. 

To medical oncers of the United States Public Health Service: 

Specimens of blood forwarded from marine hospitals and other 
stations to the Hygienic Laboratory must be prepared in the fol- 
lowing manner : For Wassermann test, 10 c. c. of blood must be re- 
moved from an arm vein with a sterile needle and syringe, and placed 
at once in a large test tube, or if there is a centrifuge available, in a 
centrifuge tube. After the clot has become hard it should be sepa- 
rated from the wall of the tube with a sterile needle, and then allowed 
to contract in a cool place (overnight in the ice box) until an ample 
amount of the clear serum is separated. If a centrifuge is available, 
a clearer serum may be obtained by centrifuging, but if not, it is 
sufficient to j)ipette off or carefully decant the clear serum into a 
sterile rubber-stoppered glass vial. The stopper having been firmly 
inserted and the vial labeled with identifying marks, the specimen 
should be protected by wrapping with cotton, packed, and marked in 
accordance with the postal regulations. For Widal test, the same 
technique must be followed, but 5 c. c. of blood will be sufficient. 

The postal regulations, a copy of which is inclosed, should be 
strictly followed in the transmission of pathological tissues or fluids. 
Bottles and mailing cases for your use will be sent from the Purvey- 
ing Depot. If any more bottles or mailing cases are desired, requisi- 
tion should be sent to the depot. When a specimen is forwarded to 
the Hygienic Laboratory, the bottle and mailing case will be returned 
to you for further use. 

Great care should be exercised in labeling the specimens, so that 
full identification is possible, and the nature of the examination de- 
sired should be briefly stated on the label, since it frequently happens 
that the letter giving these particulars is not received as soon as the 
specimen itself. A brief clinical history should be transmitted with 
each specimen. 

Kupert Blue, 

Surgeon General. 

Blood should be drawn before meals to avoid excess of chyle in the 
serum. 



41 

Requisitions for Blanks and Books. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ January 22^ 1915. 

Bureau Circular Letter No. 54. 

Medical officers and other employees, United States Public Health 
Service : 

Your attention is called to the inclosed copies of the new edition 
of Form 1906, and you are directed to use this new blank exclusively 
in making- requisitions for blanks and books, and to immediately 
destroy all old copies of this form now on hand. 

It will be observed that there has been added to this form a 
considerable number of blank books, which the bureau believes 
may be found very useful at some of the stations of the service. 
However, it is desired that these books be asked for only after careful 
consideration as to the need for the same, and the quantities re- 
quested should be limited to actual necessities. In general, the 
blank books of small size and of few pages will be found most useful 
as well as more economical to the Government, 

It is further directed that hereafter requisitions on this form be 
submitted in duplicate. 

Care should be taken that the name of the officer and the post- 
office address be clearly and legibly written. 

Attention is particularly directed to the " Instructions " on the 
final page of the requisition. Careful observance thereof will 
facilitate action and avoid the return of the paper to the officer. 

Rupert Blue, 

Surgeon General. 

Inclosures. 



Requisitions for Stationery Supplies. 

Treasury Department, 

BuilEAU OF THE PuBLIG HeALTH SeRVICE, 

Washington, January 22, 1915. 

Bureau Circular Letter No. 55. 

Medical officers, United States Public Health Service, and others 

concerned : 

Your attention is called to the attached copies of Treasury De- 
partment Forms 2162 and 2163, which are the proper forms for 
making the annual and special requisitions, respectively, for sta- 
tionery supplies. 

The annual requisition should be made on April 1 (par. 634, service 
regulations), and the quantities asked for should be kept to the 



42 

lowest minimum consistent with reasonable needs. Should necessity 
arise during the course of the year for additional supplies, they may 
be asked for in a supplemental requisition on Form 2163. 

Care should be taken that the name of the officer and the post- 
office address be completely and legibly written. 

All requisitions for stationery, both annual and supplemental, 
should hereafter be submitted in duplicate. 

Rupert Blue, 

Surgeon Generdl. 

Construction Placed Upon Executive Order Dated December 28, 1914. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ February £5, 1915. 

Bureau Circular Letter No. 56. 

Medical officers of the United States Public Health Service : 

Your attention is called to the following copy of a letter from the 
Assistant Secretary of the Treasury placing a construction upon 
Executive order dated December 28, 1914, which requires that " No 
employee shall be promoted during probation except upon the ap- 
proval of the commission previously obtained " : 

Febbuaky 9, 1915. 
The Stjegeon Genebai,, 

Public Health Service. 
Sir: By direction of the Secretary, and referring to your indorsement upon 
a communication of the medical officer in charge at San Francisco, Calif., of 
the 31st ultimo, you are informed that Executive order dated December 28, 
1914, amending civil service Rule XI, paragraph 2, in that " no employee shall 
be promoted during probation except upon the approval of the commission 
previously obtained," applies to all stations of the Public Health Service with 
the exception of those quarantine stations which are subject to the provisions 
of paragraph 7, subdivision 3, of Schedule A, of the civil service regulations, 
viz, Cape Charles, Columbia River, Fort Stanton, Gulf, Key West, Mobile, 
Mvillet Key, Reedy Island, San Francisco, and South Atlantic. 

However, recommendations may be made for the promotion, during proba- 
tion, of attendants at any of the stations of the Public Health Service other 
than those mentioned above, the approval of such recommendations being sub- 
ject to the action of the Civil Service Commission. 
Respectfully, 

Bykon R. Newton, 
Assistant Secretary. 

From this letter it will be seen that while promotions of attendants 
may be made in the event of a vacancy occurring, these promotions 
are subject to the action of the Civil Service Commission. 

Rupert Blue, 

Surgeon General. 



43 

Treatment of Officers and Other Employees of the Lighthouse Service. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, March 27, 1915. 

Bureau Circular Letter No. 57. 

To oficers in charge of marine hospitals and relief stations of the 

United States Public Health Service : 

In accordance with department approval of March 16, 1915, you 
are informed that hereafter hospital and out-patient treatment shall 
be furnished to officers and other employees of the Lighthouse Serv- 
ice who are not entitled to free treatment under the provisions of 
paragraph 459, regulations of the service, and that for such treat- 
ment the service is to be reimbursed by the Department of Commerce 
at the same rates as are now, or may be hereafter, charged for the 
treatment of officers and enlisted men of the United States Army 
and Navy. For rates of charge, see page 28 of Treasury Decisions 
No. 34,559, dated June 16, 1914. Bills for reimbursement should be 
rendered in duplicate on forms 1927 and 1928 and both the original 
and duplicate forwarded to the bureau for the proper adjustment of 
funds. 

Patients admitted to treatment at stations of the service, in ac- 
cordance with the above, are not subject to the provision relative to 
the transfer of patients to marine hospitals. Each applicant for 
relief must present a written application signed by his superior officer 
or the officer in charge of his party. 

Rupert Blue, 
Surgeon General. 



Use of Government Transportation Requests. 

Treasury Department 



Bureau of the Public Health Service, 

Washington, April 7, 1915. 

Bureau Circular Letter No. 58. 

To officers in charge of marine hospitals and relief stations of the 

United States Public Health Service : 

You are informed that, in accordance with department approval 
of March 18, 1915, transportation for patients from relief stations 
to marine hospitals, and from one marine hospital to another (not 
including the transfer of patients to Fort Stanton, N. Mex.), shall 
be obtained hereafter on Treasury Department transportation re- 
quests, a limited supply of which are inclosed herewith. You are 



44 

authorized, therefore, to countersign said requests when used for 
the purpose indicated, provided : 

1. That the transfer is authorized in the annual circular entitled 
" Contracts for the care of seamen, etc." 

2. That if not authorized in said circular the transfer has been 
authorized by the bureau in accordance with provisions contained in 
paragraph 527, regulations of the service. 

You are also authorized to countersign the above-mentioned re- 
quests when used in obtaining transportation for attendants re- 
quired to accompany patients in their transfer from one station to 
another, provided special authority in each case has been obtained 
from the bureau. 

In using the inclosed requests the instructions contained in the 
" Notes on transportation requests," instructions printed on the back 
of each request, and the special instructions given below must be 
complied with. If, after reading these instructions, you are not sure 
as to how said requests should be issued and used, you should at once 
request information as to the same. 

The Comptroller of the Treasury has ruled that, when counter- 
signed, transportation companies who accept Government requests 
in good faith are entitled to reimbursement for transportation fur- 
nished thereon. You are informed, therefore, that care should be 
taken to see that the inclosed requests (or requests forwarded to you 
in the future) are not lost or stolen, as transportation might in that 
event be secured on same by forgery. All requests for transportation 
should be kept under lock and key. 

Requisitions for additional supplies of transportation requests 
should be made in letters addressed to the bureau, and should be 
made to cover, as nearly as possible, a period of sis months. 

You are directed to acknowledge the receipt of this circular letter 
and the inclosed transportation requests. 

Rupert Blue, 
Surgeon General, 

SPECIAL INSTRUCTIONS. 

1. Date each request when issued. 

2. Give full name of the transportation company. 

3. Give full name of the traveler in whose name a request Is issued and the 
number of other persons to be furnished transportation on the same request. 

4. If more than one person is to be furnished transportation on one request, 
the names of the other persons should be written on the back of the request at 
the end next to the stub. 

5. Give names of places to and from which transportation is to be furnished. 

6. If more than one transportation company is involved, give the initial of the 
other companies In the space provided for that purpose. 

7. State the number and class of tickets to be furnished — as one first-class 
limited ticket. 



I 



I 



45 

8. If sleeping-car accommodation is to be furnished, give the number of upper 
or lower berths and whether in standard or tourist sleeper — as one standard 
lower (or upper) berth, or one tourist lower (or upper) berth. Sleeping-car 
accommodations should not be furnished unless absolutely required. All space 
not reqiiired should be stricken out. 

9. It is necessary that the kind of transportation or accommodations to be 
furnished be clearly indicated in each request and that the spaces not required 
be stricken out. 

10. Below your M^ritten countersignature stamp or write your official title. 

11. The traveler in whose name a request is issued must certify thereon that 
the transportation was actually received by him. In preparing this certification 
the following instructions should be carried out : 

(a) The name of place and date should in all cases be given in spaces pro- 
vided for that purpose. 

(6) If transportation was "furnished as above" the words "or as follows" 
and all blank spaces (other than spaces for place and date) should be canceled. 

(c) If transportation was not " furnished as above " the traveler should state 
in the proper spaces exactly what was furnished — as one first-class limited 
ticket or one standard lower berth. 

12. The official title should be given after the signature of a traveler in his 
certification on a transportation request. If the traveler is a seaman, the word 
" Seaman " should follow such signature. 

13. The stub to which each request is attached must be filled out as indicated 
thereon. 

14. The memorandum copy of each request must be forwarded to the bureau 
as soon as the original request is issued. 

15. Each book of stubs, together with any spoiled requests, should be for- 
warded to the bureau. 

16. The provisions contained in paragraph 7, Treasury Decisions No. 34559, 
dated June 16, 1914, should be disregarded, as transportation companies will 
render their own bills based upon the requests received and honored by them. 

17. Transportation requests should not be given to patients, but the officer 
who issues a transportation request should obtain the ticket and deliver same 
to the patient. The officer should see that the patient after he has been provided 
with a ticket proceeds on his journey. 

18. Referring to paragraph 528, regulations of the service, you are informed 
that hereafter in each case where a sick or disabled seaman is furnished rrans- 
portation to a marine hospital for treatment, two relief certificates, respectively 
indorsed on the outer fold " Original " and " Duplicate," shall be made out and 
signed at the station where transportation is furnished. The original will be 
forwarded to the medical officer in charge of the marine hospital where the 
seaman is to be admitted and the duplicate delivered to the seaman for presenta- 
tion to the said medical officer. Upon the admission of the seaman at the 
marine hospital the medical officer in charge shall 'forward the original relief 
certificate to the bureau with the date of his admission noted on the outer fold 
thereof. If, after a reasonable period, a seaman does not present himself the 
officer in charge of the marine hospital shall forward the original relief certifi- 
cate to the bureau with a notation mado on the outer fold thereof that said 
seaman did not present hiinself for admission to hospital treatment. The 
memorandum copy of transportation requests to be forwarded to the bureau, in 
accordance with paragraph 14, takes the place of the " triplicate " relief certifi- 
cate heretofore issued. 



46 

Relative to the Transfer of Patients to Marine Hospitals. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ April 7, 1915. 

Bureau Circular Letter No. 59. 

To officers in charge of relief stations of the United States Public 

Health Service: 

Referring to Bureau Circular Letter No. 58, relative to the use of 
Government requests for transportation, it is thought that as an ex- 
planation of the reasons underlying the instructions given in para- 
graph 5, Treasury Decisions No. 34559, dated June 16, 1914, the fol- 
lowing remarks relative to the transfer of patients to marine hospitals 
for treatment may be of value in that the conditions governing the 
transfer of said patients may be better understood. 

1. The cost for the care and treatment of a patient at a marine hos- 
pital is about 50 cents a day. Whether or not a patient should beB 
transferred to a marine hospital (considered only from an economic 
standpoint) depends, therefore, on whether a saving would be effected 
by taking such action. The points to be considered are: First, the 
length of treatment probably required ; second, the per diem cost of 
treatment at the relief station ; third, the cost of transportation ; and, 
fourth, the per diem cost of treatment at the marine hospital. | 

2. In no case is it expected that a patient shall be transferred to a 
marine hospital for treatment if his chances for ultimate recovery are 
lessened by so doing, or that his physical condition will be unfavor- 
ably affected. 

3. As a general rule to be followed, a patient who requires more 
than 20 days' hospital treatment (if it appears that he can bear trans- 
portation without injury and without the services of an attendant) 
should be transferred to the nearest marine hospital for treatment, 
provided such transfers are authorized in annual circular entitled 
" Contracts for the care of seamen, etc.," in accordance with the fol- 
lowing instructions : 

(a) Should a patient apply for treatment and be able to bear transporta- 
tion without an attendant, he should be transferred at once without admitting 
him to treatment at the local contract hospital to the nearest marine hospital, 
provided he requires treatment, in your opinion, for a period of 20 days or more, 
if said transfer is authorized in the above-mentioned circular. 

(&) Assuming that it is necessary to admit a patient to the local contract 
hospital for treatment, he should be transferred to the nearest marine hospital 
for further treatment as soon as he has improved to such an extent that he can 
bear transportation without injury, if at such time it is considered that a 
further period of 20 days' treatment will be required, as stated in the previous 
part of this paragraph. 

4. If authority is not given in the annual circular entitled " Con- 
tracts for the care of seamen, etc.," for the transfer of patients from 



I 



I 



47 

your station to the nearest marine hospital, authority should at once 
be requested from the bureau for the transfer of a patient (subject 
to transfer as mentioned in paragraph 3), as provided for in para- 
graph 527, regulations of the service. 

5, In case a patient requires the services of one or two attendants 
in order to transfer him to the nearest marine hospital, and he can 
thus be transferred without injury, recommendation that the neces- 
sary attendants be detailed or appointed to make the transfer should 
at once be made to the bureau. In making such a recommendation, 
you should state the number of attendants required and the probable 
period of hospital treatment required. 

Rupert Bltie, 

burgeon General. 

Narcotic Supplies for Lighthouse Vessels. 

Treasury Department, 
Bureau oe the Public Health Service, 

W ashing ton., April ^^, 1915. 

Bureau Circular Letter No. 60. 

To medical officers of the United States Public Health Service : 

The Commissioner of Internal Revenue has informed this bureau 
that officers of this service may furnish certificates to officers of the 
Lighthouse Service so that they may purchase narcotic supplies for 
use of persons upon their vessels. 

You are therefore directed to issue these certificates upon applica- 
tion of these officers, signing them in your official capacity. 

A. H. Glennan, 
Acting Surgeon General. 



Instructions Regarding the Administration of Antityphoid Vaccine. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ May 29, 1915. 

Bureau Circular Letter No. 61. 

2'o medical officers of the Public Health Service: 

The following directions should be observed in immunizing per- 
sons against typhoid fever : 

The first dose is one-half c. c. (7^ m.) ; the second and third are 
each 1 c. c. (15 m.). An interval of at least seven days should elapse 
between doses. This interval may be extended to the fourteenth day 
in case of necessity, but after that date previous inoculation should 
not be counted. 



11 



48 

The site of the inoculation is the arm at the insertion of the 
deltoid muscle. If for any reason this site can not be used, the 
needle may be introduced in the back, over the lower portion of 
the scapula or in the chest below the clavicle. The dose to be given 
subcutaneously, and not into the muscles, not into the skin. The 
arm should be cleansed as for any other operation. Tincture of 
iodine painted over the dry skin before and after the injection has 
proven satisfactory. 

The ampule should be washed off in an antiseptic solution and 
opened after making one or more cuts near the top with a file. The 
vaccine can be drawn out of the container with a syringe, or it may 
be emptied into a shallow glass dish, such as a salt cellar, which has 
been sterilized by boiling. 

The syringe and needle should be sterilized by boiling in 2 per 
cent soda solution. To insure perfect sterilization. draw the piston 
out to its full length or remove it entirely, so that the barrel is full 
of water during the boiling. A fresh needle should be used for 
each person, or, if one needle must be used on two or more persons, it 
should be resterilized before each injection. 

No person should be immunized who is not perfectly healthy and 
free from fever. The temperature should be taken before immuniza- 
tion is begun, and in doubtful cases the urine should be examined; 
if fever or any other symptoms of illness are present, the procedure 
should be postponed. Neither beer nor alcohol in any form should 
be drunk on the day of treatment. The prophylactic is borne well 
' by children and by women, and doses proportionate to the body 
weight should be used. Women should not be given the first dose^ji 
during or near the time of the menstrual period. i 

The most suitable time for the administration is about 4 o'clock 
in the afternoon, as the greater part of the reaction is then over by 
morning. There is usually some headache and malaise, and a local 
reaction consisting of a red and tender area about the size of the 
palm of the hand, and sometimes tenderness in the axillary glands. 
Earely marked general reactions occur — headache, backache, nausea, 
vomiting, herpes labialis, occasionally albuminuria, and some loss 
of body weight. The number of such reactions is exceedingly small, 
and, regardless of their severity, they as a rule disappear inside of 
48 hours. 

Antityphoid vaccine can be obtained by sending a requisition for 
the desired amount to the Director of the Hygienic Laboratory, 
Public Health Service, Washington, D. C. Glass syringes and 
needles can be obtained from the Purveying Depot, Public Health I 
Service, 1414 Pennsylvania Avenue NW., Washington, D. C. 

A. H. Glennan, 
Acting Surgeon General, 



49 

Vaccination Against Typhoid Fever. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, July i, 1915. 

Bureau Circular Letter No. 62. 

To medical officers and other employees, United States Public Health 

Service : 

You are requested to inform the bureau if you have ever been 
vaccinated against typhoid fever or if you have had an attack of 
this disease. If such is the case, you are directed to fill in the in- 
closed blank and return same to the bureau. If you are under 55 
years of age and have never had this disease and have never been 
vaccinated against it, you are advised to have this vaccine adminis- 
tered to yourself, the blank to be then completed and mailed to the 
bureau. 

The enlisted men and officers of the United States Army, Navy, 
Coast Guard, Coast and Geodetic Survey, and Lighthouse Services 
are now protected by vaccination against typhoid fever, and it is 
the desire of this bureau to have all officers and employees of the 
service take advantage of this prophylactic. The necessity for this 
action is emphasized by information recently received by the bureau 
that a commissioned officer of this service is suffering from typhoid 
fever. 

Before an attendant is nominated for employment in this service 
he should be asked if he is willing to be vaccinated against typhoid 
fever, and a written statement to that effect should accompany his 
nomination. As soon as the approval of the nomination is received 
the vaccine should be administered and a report to that effect sent 
to the bureau. 

The receipt of this circular letter should be promptly acknowl- 
edged. 

A. H. Glennan, 
Acting Surgeon General. 



Compliance With State and Loca' Laws and Regulations to be Carefully 

Observed. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, June 8, 1915. 

Bureau Circular Letter No. 63. 

To oiflcers of the United States Public Health Service: 

Your attention is invited to paragraph 133 of the service regula- 
tions, reading, in part, as follows : " Commissioned officers shall obey 
14330°— 21 4 



50 

the local health laws in force at their respective stations when not 

* * * in conflict with national health laws and regulations 

* * *." The requirement of this paragraph applies not only to 
health laws but to regulations promulgated pursuant to law. 

Officers of the Public Health Service are directed to familiarize 
themselves with the State and local requirements regarding the 
notification of cases of disease, wherever they may be stationed, and 
to carefully observe the requirements whenever they have cases of 
any notifiable disease under their care. 
These instructions apply to all officers of the service. 
The receipt of this letter is to be acknowledged. 

A. H. Glennan", 
Acting Surgeon General 



I 



The Use of Penalty Envelopes and Labels. 

Treasury Department, 
Bureau of the Public Health Service, 

W ashing ton^ June 11, 1915. 

Bureau Circular Letter No. 64. 

To officers and others concerned, UnitedStates Public Health Service: 
For your information the following statement of the law governing 
the use of penalty envelopes and penalty labels is quoted from the 
"■ United States Postal Laws and Regulations " : 

Sec. 496. It shall be lawful (for all officers of the United States Government 
* * *) to transmit through the mail, free of postage, any letters, packages, 
or other matters relating exclusively to the business of the Government of the 
United States * * *. 

* * * Any department or officer authorized to use the penalty envelopes 
may inclose them with return address to any person or persons from or through 
whom official information is desired, the same to be used only to cover such 
official information and indorsements relating thereto * * *. 

Whoever shall make use of any official envelope, label, or indorsement author- 
ized by law to avoid the payment of postage or registry fee on his private 
letter, packet, package, or other matter in the mail shall be fined not more 
than $300. 

It should be noted that the use of penalty envelopes and penalty 
labels is unlawful except when the matter transmitted relates " exclu- 
sively to the business of the Government of the United States." M 

A. H. Glennan, " 

Acting Surgeon General. 



51 

Annual Reports. 

Treastjky Department, 
Bureau of the Public Health Service, 

Washington^ June 16, 1915. 

Bureau Circular Letter No. 65. 

To commissioned m^edical oflcers, acting assistant surgeons, and 

others concerned: 

Your attention is called to the necessity of forwarding annual re- 
ports of transactions for the fiscal year ending June 30, 1915, 
promptly after the close of the fiscal year. Legislation by Congress 
requires the submission of annual reports of all Government depart- 
ments and bureaus at an earlier date than has heretofore been neces- 
sary, and it is directed that copy of annual reports from all stations 
of the service be sent to the bureau not later than July 25, 1915. 

A. H. Glennan, 
Acting Surgeon General. 



Nominating Temporary Acting Assistant Surgeons. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, June 19, 1915. 

Bureau Circular Letter No. 66. 

To medical officers in charge of stations, United States Puhlic Health 

Service : 

For the special attention of those officers on duty at stations where 
physical examinations requiring eye tests are held : 

When it becomes necessary to employ the services of a local physi- 
cian for temporary duty, an examination should be made of his eyes 
(with the woolen skeins alone if a Williams lantern is not available) 
to determine his vision and color sense. A report of the results should 
be mailed to the bureau on the inclosed form letter. 

A. H. Glennan, 
Acting Surgeon General. 



Instructions as to the Preparation of Vouchers for Gas, Electric Current, 

and Water. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, July 6, 1915. 

Bureau Circular Letter No. 67. 

To medical officers in charge. United States Puhlic Health Service: 

In submitting vouchers for gas, electric current, and water, par- 
ticular attention should be given to the matter of deducting discount 



52 

for making prompt cash payment within the specified discount 
period, the amount of the deduction to be shown on the face of the 
voucher. 

In cases where a cash discount for prompt payment will not be 
allowed by the contractor, or where the contract rate is net, without 
further deduction for prompt cash payment, the following statement 
should appear on the face of the voucher : 

" Not entitled to cash discount." 

A. H. Glennan, 
Acting Surgeon General. 



Relative to the Issuance of Bills for the Care and Treatment of Certain 
Employees of the Lighthouse Service. 



I 



Treasury Department, 
Bureau or the Public Health Service, 

Washington^ August 9, 1915. 

Bureau Circular Letter No. 68. 

To commissioned medical officers^ acting assistant surgeons, and 
others concerned : ^ 

The following letter has been received from the Commissioner o:^ 
Lighthouses, Department of Commerce, under date of August 6, 
1915, relative to the issuance of bills for the care and treatment of 
certain employees of the Lighthouse Service, as provided for in 
Bureau Circular Letter No. 57, dated March 27, 1915 : 

Referring to the matter of furnishing treatment to employees of the Light- 
house Service, as provided by Circular Letter No. 57 of your bureau, dated 
March 27. 1915. 

This bureau begs to suggest that the settlement of accounts for services ren- 
dered in such cases may be expedited if the bills, before being transmitted by 
the local hospital or station to your bureau in Washington, D. C, are approved 
by the officers of the Lighthouse Service who made the application for treat- 
ment. After the receipt of the bills at this bureau from your office it is neces- 
sary under present practice to refer them to the proper officer of the Lighthouse 
Service for approval, which consumes time that might be obviated as explained 
above. If this suggestion meets with your approval, the lighthouse inspectors 
will be requested to cooperate with the Public Health officials in this matter. 

It is also requested that, if practical, bills for this service be rendered to this 
bureau in duplicate, in order that one copy may be retained for the files of this 
office, the original being referred to the Auditor for the State and Other Depart- 
ments with the account for settlement. 

In order to comply with the request made by the Commissioner of 
Lighthouses you are directed, first, to prepare bills in triplicate for 
the care and treatment of persons mentioned in the above-mentioned 
circular, and, second, to have these bills approved by the proper offi- 
cer of the Lighthouse Service before forwarding same to the bureau. 

KuPERT Blue, 

Surgeon General. 



53 

Amendment to Civil Service Rules Relating to the Appointment of 

Employees. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, August 17, 1915. 

Bureau Circular Letter No. 69. 

To commissioned medical officers, acting assistant surgeons, and 

others concerned: 

You are informed that paragraph 7 of subdivision 3 of Schedule A 
of the Civil Service Eules, entitled " Classified positions excepted 
from examination under Rule II, clause 3," has been amended by 
Executive order, dated August 6, 1915, which reads as follows: 

EXECUTIVE OKDEK. 

Paragraph 7, Subdivision III of Schedule A of the Civil Service Rules is 
hereby amended to read as follows : 

" 7. In the Public Health Service attendants employed at not more than $50 
per month in the United States or at any salary elsewhere ; scientific assistants 
employed temporarily for periods not to exceed six months, or longer with the 
prior approval of the commission, in investigations of contagious or infectious 
diseases and matters pertaining to the public health ; and quarantine attendants, 
acting assistant surgeons, or sanitary inspectors on quarantine vessels or in 
camps or stations established for quarantine purposes during an epidemic of a 
contagious disease for temporary duty in the United States or elsewhere in pre- 
venting the introduction or spread of contagious or infectious diseases." 

This order is recommended by the Secretary of the Treasury and the Civil 
Service Commission. Its effect is to except from examination attendants at not 
more than $50 per month who were subject to competitive examination, and 
scientific assistants who have ordinarily been appointed temporarily in the 
absence of registers. The appointment of attendants through examination has 
been unsatisfactory because of the lack of applicants rarely exceeding the 
number of appointments to be made and frequently being less. 

WooDRow Wilson. 
The White House, August 6, 1915. 

It will therefore be no longer necessary to maintain lists of eli- 
gible stations of the service or to forward transcripts thereof to the 
bureau on the 1st day of each month as required by paragraph 75 
et sequitur of the service regulations. 

All attendants at a salary of $50 per month or less will be selected 
by the medical officers in charge of stations and the names so se- 
lected forwarded to the Surgeon General for approval, stating the 
exact date on which the services are to be eifective, and the rate of 
compensation, also the compensation received by the predecessors. 
Vacancies will be reported as now required by paragraph 79 of the 
service regulations. 



54 

When the salary of the vacant position exceeds $50 per month, a 
request will be made upon the district secretary by the medical 
oiBicer in charge for a list of eligibles from which to make selection. 
The indorsement of the district secretary must appear on the letter of 
nomination submitted to the bureau. 

The status of employees now serving under a probationary or per- 
manent appointment with compensation at a rate greater than $50 
per month and who have been appointed without examination will™ 
not be changed or disturbed. « 

It will be noted that no stations of the service are now excepted 
from the operation of this paragraph by name, but the exceptions; 
permitted apply to all equally. 

Vacancies in positions where the salary is more than $50 per month 
must be filled from registers of the commission maintained in the 
offices of its district secretaries. When necessary, examinations may 
be specially announced and will be practical in character. At- 
tendants already in the service may take these examinations. 

A list of the civil-service districts is inclosed. 

EuPERT Blue, 

Surgeon General. 



Information as to the Right of Medical Taeatment by Officers and Enlisted 
Men of the United States Coast Guard. 



\ 




Treasury Department, 
Bureau of the Public Health Service, 

Washington, August 23, 1915. 

Bureau Circular Letter No. 70. 

To co'inmissioned medical officers, acting assistant surgeons, customs 

officers, and others concerned: 

In accordance with act of Congress approved January 28, 1915, 
you are informed that officers and enlisted men of the United States 
Coast Guard are entitled to the same medical treatment as is pro- 
vided by the regulations of the service for officers and enlisted men 
of the former United States Revenue- Cutter Service. 

The United States Coast Guard is, in accordance with tike above- 
mentioned act, composed of officers and enlisted men of what was 
formerly known as the " United States Revenue-Cutter Service " and 
" United States Life-Saving Service." 

Rupert Blue, 

Surgeon General. 



55 

Relative to Inspection of Unserviceable Property. 

Treasury Department, 
Bureau of the Pubijc Health Service^ 

Washington, August 23, 1915. 

Bureau Circular Letter No. 71. 

To commissioned medical officers, acting assistant surgeon^s, and 

others concerned: 

Medical officers detailed to inspect unserviceable property shall be 
governed by the following instructions : 

Furniture. — The appropriation for furniture requires that the de- 
partment shall employ old and available furniture in its buildings, 
whether it conforms to that in use or not. All furniture which can 
be suitably repaired and made serviceable should be continued in 
service. 

Typewriters. — If considered unserviceable, should be recommended 
to be returned to the Purveying Depot. 

Window shades. — These should not be condemned if they can be 
rendered serviceable by cleaning or turning end for end. 

Carpets and rugs. — These should not be condemned unless badly 
worn. 

Hair mattresses and hair and feather pillows. — These should not 
be condemned, but continued in service, as their contents can be 
renovated and new ticking furnished at less than the cost of new 
mattresses or pillows. 

Cotton mattresses. — If unserviceable, should be condemned, as 
the cost of renovating these mattresses is greater than the cost of new 
ones. 

Aluminum ware. — Unless broken, all articles of this material 
should be continued in service, as the holes can be patched and dents 
removed. 

Books. — Before any recommendation is made, the author's name 
and the date of publication should be cited on the report. Those 
considered unserviceable by reason of age or condition should be 
recommended to be sold. 

Surgical instru7nents and appliances. — Any of these articles which 
can be rendered serviceable by cleaning, polishing, or by the purchase 
of repair parts should be continued in service. They should not be 
condemned simply because they are rusty, dull, or have hard rubber 
handles. Hypodermic syringes should not be condemned if they 
can be rendered serviceable by the use of new washers or plungers 
or by the replacing of broken parts. Hand atomizers should not be 
condemned if new bulbs or containers will permit of their use, as 
these parts can be obtained from the Purveying Depot. 

Ruhher goods {including hose). — Articles of this nature, if no 
longer serviceable, should be recommended to be sold. 



56 

Hose couplings. — These should be retained in service, so that it 
will be unnecessary to buy new couplings when new hose is pur- 
chased. 

A note should be placed in the column for remarks of the exact 
condition of all articles condemned and of those recommended to be 
sold. 

Paragraph 594 of the Regulations should be strictly complied 
with, and medical officers should be instructed to expedite this work 
by employing their force during the inspection to prepare for burn- 
ing or other disposal, as the case may be. 

Rupert Blue, 

Surgeon General. 

List of Expendable Property. 

Treasurt Department, 
Bureau of the Public Health Service, 

Washington, August 24, 1915. 

Bureau Circular Letter No. 72. 

To medical officers, United States Public Health Service: 

The following is a revised list of expendable property. All articles 
previously declared expendable, in accordance with paragraph 582 
of the regulations, and not included herein, are to be treated as non- 
expendable property and are to be accounted for on the property 
return of the service rendered from each station. 

Expendable medical, surgical, and stationery supplies. (Bureau 
Circular No. 10, dated Dec. 15, 1911.) 

Paragraph 583 of the regulations relative to obsolete books and 
other publications. 

Paragraph 587 of the regulations relative to materials for repairs. 

Batteries, dry. Oilcloth, table and shelf. 

Batteries, wet. Pin cushions. 

Brushes, tooth. Slide boxes. 

Chalk lines. Spitcup papers A. 

Cloth, cheese. Spitcup holders. 

Clothespins. Spitcups and mugs. 

Flannel cloth. Splints, basswood. 

Fly killers. Splints, bone. 

Hose for gas range or stove. Splints, porous. 

Indelible ink outfit. Sponges, bath. 

Inkpads. Sponges, surgical. 

Needles, Emmett's. Stirring rods, glass. 

Needles, intestinal. Tubes, drainage. 

Needles, Mayo's. ■ Tubes, glass. 

Needles, suture. Tubes, rubber. 

Noxxles, glass. Watch glasses (for microscope). 

Rupert Blue, 

Surgeon General. 



57 

Relative to Emergency Purchases of Medicines. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, September 7, 1916. 

Bureau Circular Letter No. 73. 

Medical officers, United States Public Health Service, and others 

concerned : 

Owing to conditions caused by European war prices for the 
following articles regularly issued by the Purveying Depot have 
so advanced in price that our small appropriation prevents their 
purchase except in small quantities : 

Acetanilid, Salvarsan, 

Benzoic acid, Novocaine, 

Oxalic acid, Aspirin, 

Adrenalin chloride solution, Plienol, 

Adeps lanae liydrosus, Potassium salts, 

Balsam of Peru, Resorcin, 

Beta naplithol, Sodium salicylate, 

Bismuth salts, Sulphonal, 

CJiloral hydrate, Trional, 

Chloroform venale, Thymol, 

Chromium triozide, Thymol iodide, 

Mercury salts, Trikresol, 

Neosalvarsan, Veronal, 

and all chemicals appearing in List of Awards for 1916 on which no 
award has been made. 

In some instances, such as phenol, the cost of which is more than 
nine times greater than that paid last year, none at all was bought. 
We are advised that novocaine and aspirin are practically unobtain- 
able. For these reasons you are requested to use sparingly all drugs 
and chemicals the cost of which has materially advanced, prescribing 
inexpensive preparations wherever it is possible to do so. 

Emergency purchases of medicines should not be made except 
when absolutely necessary, and then only in quantities sufficient for 
the immediate needs of your station. 

EuPERT Blue, 

Surgeon General, 

Physical Examination of Able Seamen. 

Treasut{T Department, 
Bureau or the Public Health Service, 

W ashington, September 15, 1915. 

Bureau Circular Letter No. 74, 

To medical officers of the United States Public Health Service: 

An act to promote the welfare of American seamen in the merchant 
marine of the United States, etc., approved March 4, 1915, provides 



58 

that a percentage of the deck crew on all American vessels must be 
able seamen. It also provides that each able seaman shall have a 
certificate of service, which can only be issued after he has been found 
competent " upon examination, under rules prescribed by the De- 
partment of Commerce, as to eyesight, hearing, physical condition, 
and knowledge of the duties of seamanship." 

In order that the provisions of this act may be enforced, you are 
directed to make a physical examination of any person desiring to be 
rated as an *' able seaman," upon the presentation of a request on the 
proper form issued by the Department of Commerce, and record the 
result on the blank attached to this request, carefully following the 
instructions which accompany it. This blank, after completion, 
should be returned to the applicant. 

These examinations should be entered in the record of medical 
inspection of seamen (Form 1991, P. H. S.). 

Rupert Blue, Surgeon General. 



Physical Examinations for the Coast Guard. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, September 15, 1915. 

Bureau Circular Letter No. 75. 

To medical officers of the United States Public Health Service: 

An applicant for reenlistment who had received an honorable dis-4 
charge and who has been separated from the Coast Guard for more 
than 30 days, or an applicant who has received an ordinary discharge 
with recommendation for reenlistment, who has been separated from 
the Coast Guard for more than 10 days, shall be required to pass the 
physical examination for original enlistment and should be rejected 
unless he fulfills the requirements of this examination. The date 
and form (honorable or ordinary) of discharge from the Coast Guard 
should be obtained from the enlisting officer and should be placed in 
the certificate on page 6 of Form No. 2592. 

Attention of officers is called to the statement on the back of Form 
No. 2502, which reads as follows : " 4. Applicants having teeth with I 
unfilled cavities, plates, or with many teeth missing, unless the miss- 
ing teeth are replaced by bridge work, should be rejected." In the 
preceding sentence more than three teeth missing shall be regarded as 
" many teeth missing." He should be advised to have decayed teetii 
filled, after which he may again appear for a continuance of his 
physical examination. If the decayed teeth can not be filled, he 
should be advised to have them extracted, but the total number of 
teeth missing must not be more than three unless they have been re- 
placed by bridge work. 



59 

A candidate desiring to enlist as a seaman should not be rejected 
on account of flat feet unless the condition is extreme and is accom- 
panied by foot strain, as it is found that this defect will not, as a rule, 
interfere with his duties as a seaman. However, if a candidate ap- 
plied for original enlistment as a surfman it is important because of 
the patrol duties which surfmen have to perform that they be free 
from this defect, and they should not be accepted if it is present in a 
degree which would be liable to interfere with the performance of 
this duty. 

A candidate for original enlistment whose diastolic blood pressure 
is more than 100 or less than 70, or whose systolic blood pressure is 
more than 130 or less than 100, should be rejected. Care should be 
taken wlipn obtaining this blood pressure to see that the sphygmom- 
anometer gives the correct reading. These instruments frequently 
get out of order and give a false impression of the condition present. 
This blood pressure should be taken in a quiet room by the auscula- 
tory method, which is as follows : After the cuff has been applied to 
the arm and filled with air a stethoscope should be placed over the 
bend of the elbow and the pressure of the air gradually released from 
the cuff. The systolic pressure should be read when the first beat of 
the pulse is heard through the stethoscope and the diastolic pressure 
should be recorded when the loudness of the pulse sound diminishes 
in intensity. 

Vision should always be stated in "20th's," in accordance with 
paragraph XV, page 134, Appendix to the Service Regulations, but 
no candidate for original enlistment should be accepted if his uncor- 
rected vision is not 20/20 each eye. Attention is invited to page 8, 
Form 2502, United States Coast Guard, Instruction No. 1, which 
states that applicants using eyeglasses are not eligible for original 
enlistment. Therefore in cases of original enlistment the sj)ace 
allotted on page 3 of Form 2502 for recording the vision " with 
glasses " should be disregarded. 

In conclusion, if a candidate for original enlistment in the Coast 
Guard presents himself before you for physical examination and has 
any defects of such character as to incapacitate him for the perform- 
ance of his duties therein, but which can be remedied by treatment in 
a hospital or otherwise, he should be rejected and advised to take 
proper treatment which will remove the cause for rejection, after 
which he may again appear for reexamination. However, no person 
who presents himself for original enlistment should be advised to 
have an operation performed requiring the opening of the abdomen, 
as no one having a scar caused by abdominal operation should be 
accepted. 

KuPERT Blue, 
Surgeon General. 




60 

Recording Physical Examinations. 

Treasuey Department, 
Bureau of the Public Health Service, 

Washington^ /September 20, 1915. 

Bureau Circular Letter No. 76. 

To medical officers of the United States Public Health Service: 

All physical examinations made (including civil-service appli- 
cants) should be recorded in record of medical inspection of seamen, 
Form 1991, and the same reported to the bureau at the end of each 
fiscal year on Form 1934. This record should, of course, not include 
examinations made of applicants applying for treatment. 

Kupert Blue, 
Surgeon General. 



Members of the Coast Guard Undergoing Treatment at First or Second 
Class Stations of this Service. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, Seyteinber 20, 1915. 

Bureau Circular Letter No. 77. 

To medical officers of the United States Public Health Service : 

Unless otherwise directed by the Surgeon General of the Public 
Health Service, the captain commandant of the Coast Guard, or his 
other superior officers, no officer or enlisted man of the Coast Guard 
undergoing treatment at first or second class stations should be dis- 
charged until he is fit for duty. Two copies of the clinical histories 
of such patients should be forwarded to the bureau every 15 days. 

Rupert Blue, 
Surgeon General. 



Discontinuance of " Pay Voucher for Commutation of Quarters." 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, September 25, 1915. 

Bureau Circular Letter No. 78. 

C ommissioned medical officers United States Public Health Service 

and others concerned : 

Hereafter the use of Form 1948, " Pay voucher for commutation of 
quarters," will be discontinued. 

Amounts due commissioned medical officers and pharmacists for 
commutation of quarters, etc., as prescribed by paragraphs 87, 103, 
and 105 of the service regulations, will be taken up on Form 1952 



61 

and 1952a, " Pay roll for personal services," on the next line below 
the pay of such officers as are entitled to commutation, the total pay 
and total commutation on the roll to be shown separately, in addition 
to the complete total of the amount-due column, for example : 



Names and designatious. 


Period of service. 


Rate of 
pay. 


Amount 
due. 


Assistant surgeon: 


1/31/31 


$2,640.00 
July, 1915 

880.00 
July, 1915 


S220. 00 


Louis Schwartz 


Commutation 

1/31/31 


40.00 


Pharmacist, second class: 

J. Albert Wolfe 


73.33 


J. Albert Wolfe 


Commutation 

Total 


60.00 




.... $293.33 
__. 100.00 




Total pay 

Total commutation. . . 


393.33 











In the " Remarks " column, opposite each item of commutation, 
note the paragraph of the Service Regulations which provides there- 
for, for example, " Par. 103, P. H. S. Reg." 

Whenever an item of commutation appears on a pay roll, the usual 
certificate printed thereon should include, to be written in" at the end 
thereof, the following: "Where commutation is alloAved, officer has 
not been provided with quarters, etc." 

Rupert Blue, 

Surgeon General. 



Provisional Standard for Fumigation With Hydrocyanic Acid Gas. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington^ Octoher 30, 1915. 

Bureau Circular Letter No. 79. 

To oficers of the United States Public Health Service: 

When performing the cyanide fumigation of compartments, you 
will be guided by the following minimum requirements : 

1. On account of the great danger to human life from hydrocyanic 
acid gas, specific arrangements should be made for the disposition 
of the crew during the fumigation process, especially if one or two 
compartments of a vessel are to be treated. A written statement 
must be obtained from the captain or first officer of the vessel that 
the latter is ready for fumigation, and that every member of the 
crew has been accounted for as not being in the vessel, or else not 
exposed to the fumes of the gas. Persons in one compartment have 
been killed by fumes escaping from another compartment undergoing 
fumigation. 

2. Not less than 5 ounces of potassium cyanide, or 3f ounces of 
sodium cyanide, shall be used to each 1,000 cubic feet. 



Amending Instructions Relative to Physical Examinations of Able Seamen. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, October 30, 1915, 

Bureau Circular Letter No. 80. 

To medical o'jjlcers in charge of marine hospitals and relief stations. 

United States Public Health Service: 

Keferring to Bureau Circular Letter No. 74, dated September 15, 
1916, relative to making physical examinations of applicants for 
rating as able seamen, you are informed that the ansv^ers to questions 
on the eyesight, hearing, and condition of the heart and lungs should 
be placed upon page 2 of Form 983, issued by the Department of 
Commerce, Steamboat-Inspection Service, entitled " Kecord of phys- 
ical examination of an applicant for rating as able seaman," but in 
case an applicant is certified as " incompetent " for rating as an able 
seaman the reason for such certification of incompetency should not 
be placed on page 3 nor on any other portion of that blank. You 
are further informed that defects which, in your opinion, would not 
materially interfere with the discharge of the duties of an able sea- 
man should not be noted on the above blank. 



1 62 

3. To each ounce of potassium cyanide, 1 fluid ounce of commercial 
sulphuric acid 66B and 2^ fluid ounces of water shall be used. 

4. To each ounce of potassium cyanide, 1^ fluid ounces of sulphuric 
acid 66B and 2 fluid ounces of water shall be used. 

5. All ingredients shall be weighed and mixed immediately prior 
to each fumigation. 

6. All parts of the vessel shall be placed under fumigation simul- 
taneously, except such compartments as may not require fumiga- 
tion in the opinion of a representative of the United States Public 
Health Service. (Review par. 1.) 

7. All compartments placed under fumigation shall be kept closed 
for not less than one hour. 

8. The hatches of 'tween decks and the doors of subcompartments 
are to be opened prior to fumigation, and the barrel or other gen- 
erator is to be placed so as to secure the most rapid and efficient 
diffusion of the gas. 

9. All work is to be done under the supervision and to the satis- 
faction of the medical officer in charge, United States Public Health 
Service, or his representative. 

Rupert Blue, 

Surgeon General. 



63 

In regard to the instructions for making physical examinations 
printed on the back of Form 983, you are informed that paragraph 
3 thereof is amended to read as follows : 

" Pak. 3, Applicants should not be required to be vaccinated 
against smallpox or inoculated against typhoid fever, but should 
be advised, with a view to the protection of the individual and the 
public health, to be vaccinated against smallpox if not successfully 
vaccinated within the last five years, and also to be inoculated against 
typhoid fever if not already so inoculated or if they have not had 
that disease." 

Paragraph 7 of the above-mentioned blank is eliminated. 

Examinations of applicants for rating as able seamen should be 
recorded in the record book issued by the Public Health Service, 
Form 1991, entitled " Record of medical inspection of seamen." In 
such records, if an applicant is certified as " incompetent " for rating 
as able seaman, the reason for such certification should be fully 
stated, and note should also be made of defects which would not 
materially interfere with the discharge of the duties of an able 
seaman. 

You will acknowledge receipt of this letter. 

Rupert Blue, 

Surgeon General. 



Rules Governing Telegraphic Messages. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington^ November £9, 1915. 

Bureau Circular Letter No. 81. 

Medical officers and other employees, United States Public Health 

Service : 

The following rules are liereby promulgated to govern official mes- 
sages by telegraph, cable, or wireless in the Public Health Service : 

(1) Messages sent by an officer in the field shall be signed only 
with the surname and official title of the addressee and sender, omit- 
ting such portions of title as are unnecessary for identification. 
Where the official title of an officer sending a telegram is unnecessary 
the whole title may be omitted. This is practically always the case 
with Public Health Service officers. 

(2) All telegrams, except those of a nature sufficiently urgent to 
demand immediate attention, will be filed for transmission as night 
messages at night rates, and this will be plainly indicated on the face 
of the message. In some instances telegrams sent from the field to the 



64 

department in Washington, or vice versa, as day messages are re- 
ceived by the addresses after office hours and not acted upon until 
the following morning, with consequent needless expense to the 
Government. 

(3) When there is doubt as to the advisability of filing a telegram 
to a distant point as a night message, consideration will be given to 
the difference in time (in some cases several hours) between the two 
points; the length of time, usually an hour or more, required for 
transmitting and delivering telegrams; and the closing time of the 
office to which the message is addressed. 

(4) As a check against errors or omissions, an addressee, especially 
an officer in the field, immediately upon receipt of a telegram, will 
count the words and compare his count with the number entered in 
the upper margin of the telegraph blank. If a discrepancy occurs, 
request should be made upon the telegraph company for a repetition 
of the message, without additional cost to the Government. " Col- 
lect " messages show an extra word in the number of words given in 
the upper margin, but this is not billed against the Government. 

(5) Care should be exercised in the preparation of messages to 
omit useless words. The use of the telegraph will not be permitted 
when letters will accomplish the same purpose. 

(6) Official messages that are not prepaid must be plainly marked 
" Official business ; Collect ; Government rate." 

(7) In messages to Washington, D. C, the letters " D. C." should 
always be omitted from the address. 

(8) Messages to the bureau should be addressed "Blue, Wash- 
ington." 

(9) All messages from the field to the department should be ad- 
dressed to the bureau or through the Surgeon General. 

(10) Officers should register their names and addresses with the 
telegraph offices wherever stationed, even temporarily, in order that 
messages addressed to them by their surnames only may reach them 
promptly. 

(11) The service telegraphic code should be used whenever prac- 
ticable. 

(12) Officers and other employees possessing the code should keep 
the same under lock and key, and when traveling or on leave carry it 
on their persons. 

This circular letter embodies the departmental regulations set 
forth in Department Circular No. 19, August 21, 1913, to which 
attention is directed. 

EuPEET Blue, 
Surgeon General. 



65 

The New Service Telegraphic Code. 

Treasury Department, 
Bureau of the Public Health Service, 

W ashington^ November 29, 1915. 

Bureau Circular Letter No. 82. 

Medical officers and others concerned, United States Public Health 

Service : 

There is transmitted herewith a copy of the new telegraphic code 
of the United States Public Health Service, which will supersede the 
old code on January 1, 1916. This copy bears a serial number and 
your name on the reverse of the title page. It has been charged to 
you personally on the records of the bureau and should be taken up 
on your personal property return. Upon the resignation or death 
of an officer the code in his possession should be returned to the 
bureau. 

You are instructed to acknowledge receipt on the inclosed special 
blank card. All copies of the old service code in your personal pos- 
session or at your station should be forwarded to the bureau immedi- 
ately after January 1 next. 

This new code is issued, not only to obtain secrecy, when desirable, 
in the transmission of messages, but also in the interest of economy, 
and to this latter end the bureau desires that all officers give the code 
special study, observing particularly the instructions contained in the 
preface. It will be found that the code contains numerous phrases 
the use of which will result in great saving in telegraph tolls. There 
is no better way of becoming familiar with the contents and arrange- 
ment of the book than by using it as frequently as possible in official 
messages. 

Suggestions concerning the code will be welcomed by the bureau, 
and officers are urged to point out promptly any defects that may 
become evident as it is desirable to remedy them at once. 

"'^n addition to the foregoing personal copy of the code another 
copy will be sent to certain of the larger stations of the service, nota- 
bly marine hospitals, relief stations of the second class, and quaran- 
tine and immigration-inspection stations in charge of commissioned 
officers. This additional copy will be acknowledged \)-^ the officer in 
charge of the station and taken up on the station property return. 
It is furnished for the reason that each officer when absent, on either 
duty or leave status, is expected to carry his personal copy with him. 
He should then see that the " station copy " of the code is left in re- 
sponsible hands that it may be available if needed. 
14330°— 21 ^5 



66 

Attention is called to the fact that this is a confidential code and 
its contents must be kept private. Attention is further directed to 
the " Eules governing telegraphic messages " set forth in Bureau ij 
Circular Letter No. 81, strict observance of which is desired. ~ 

EuPERT Blue, 

Surgeon General. 



Suggestions for Improvement of Service Work. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, November 29, 1915. 

Bnrean Circular Letter No. 83. 

Medical officers in charge, United States Public Health Service: 

In accordance with orders issued by the Secretary of the Treasury, 
committee of improvement have been appointed for the various 
branches of the department for the purpose of making a thorough 
study of the organization and methods of work, with a view to recom- 
mending such improvements or changes as may appear to be in the 
interest of efficiency and economy in the transaction of official busi- 
ness. The committee for the Public Health Service has been organ- 
ized and has begun its work. 

The Secretary has invited all employees of the department to sub- 
mit helpful suggestions for the consideration of the committee. The 
bureau would therefore be glad to receive from you any ideas, sugges- 
tions, or recommendations looking to the promotion of efficiency and 
economy in the conduct of governmental operations at your station 
or in its relation to the bureau or department. To this end jou are 
instructed to invite written suggestions from junior officers, pharma- 
cists, or other employees at your station. It is felt that it will be 
helpful, both to employees and the committee, if the suggestions can 
be made under some general classification. It is therefore proposed 
that they be submitted under the following heads : 

(1) Methods and forms of correspondence. 

(2) Blanks and blank forms. 

(3) Files and records at the stations. 

(4) Property records and returns. 

(5) Purchase of supplies, including requisitions, proposals, and contracts. 

(6) Securing of economies at the station; elimination of wastes. 

(7) Sanitary measures at stations. 

(8) General good of the service. 

All suggestions should be submitted to you not later than December 
24. You are then requested to prepare an epitome thereof, summariz- 
ing briefly all the suggestions under the heads above named, and 
adding any desired comments or recommendations. Your own sug- 
gestions and recommendations should be submitted independently. 



67 

In addition to the summary just mentioned, you will also forward 
all the suggestions in their original form. 

Please make immediate acknowledgment of the receipt of this 
circular letter, and transmit the material called for, if possible, on or 
before January 6. 

Rupert Blue, 

Surgeon General. 



Inspection of Sanitary Conditions of Cars, Vessels, or Other Vehicles and 
Depots and Waiting Rooms Operated or Maintained for the Use of Inter- 
state Passengers. 

Treasury Department, 

Bureau of the Public Health Service, 

Washington^ February 10^ 1916. 

Burean Circular Letter No. 84. 

To commissioned medical officers^ Public Health Service'. 

The attention of all commissioned medical officers of the Public 
Health Service is respectfully invited to paragraph 138 of the Regu- 
lations for the Government of the United States Public Health Serv- 
ice, approved March 4, 1913, and to Bureau Circular Letter No. 14, 
October 4, 1913, containing provisions in addition to paragraph 138. 

It has been noted that in many instances officers who have traveled 
under official orders on trains and vessels engaged in interstate traffic 
have failed to render the reports as required. 

Hereafter it will be necessary that all officers comply with the 
regulations in this respect — a report of conditions observed to be 
made upon the completion of each item of travel under official orders, 
or an explanation in lieu thereof stating that such a report could not 
be made and the reasons therefor. 
Respectfully, 

Rupert Blue, 

Surgeon General. 

Preparation of Vouchers for Reimbursement of Traveling Expenses. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington., February 16^ 1916. 

Barean Circular Letter No. 85. 

To medical officers and em^ployees^ United States Public Health 

Service : 

The following additional instructions in the preparation of ac- 
counts for reimbursement of traveling expenses must be observed in 



68 

order to comply with requirements of the accounting officers of the 
Treasury Department: 

The actual expenses should be inserted on the voucher under the 
proper dates, stating the names of the places visited and giving the 
hour and date of arrival and departure therefrom. 

Reimbursement for subsistence is limited by law to $5 per day. 
Subsistence includes expenditures for lodging, meals, baths, laundry, 
pressing clothes, fees to waiters and to bell boys. Whenever fees are 
given the exact purpose must be stated. Receipts are required toB 
support charges for lodging, laundry, pressing clothes, and hire of 
teams. No charge for laundry or pressing clothes can be allowed 
before departure from or after return to the station of the traveler. 
When charges for meals are made the cost of each meal must be 
shown separately. 

If transportation or Pullman accommodations are secured on 
transportation requests, a notation should be made on the travel 
voucher, and the memorandum copies of the transportation requests, 
completely filled in, must be forwarded to the bureau. In the event 
the traveler pays for Pullman accommodations from his own funds, 
it must be stated whether an upper or lower berth or seat was used. 

Personal effects of officers on change of station must be shipped 
on Government bills of lading, and when delivery of the effects is 
made to the carriers the memorandum copy of the bill of lading is 
to be forwarded to the bureau. 

The weight of the personal effects on which charges for drayage 
or packing is made should always be stated on the voucher, as the 
charges for packing and drayage incident to the journey are not to 
exceed 60 cents per hundred pounds of freight. 

Rupert Blue, 

Surgeon General. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington.^ Feltruary 28, 1916. 

Bureau Circular Letter No. 86. 

To commissioned medical officers and acting assistant surgeons of the 

Pvhlic Health Service: 

Referring to bureau letters dated October 6, 1915, relative to mak- 
ing physical examinations of applicants for Government positions in 
the classified civil service and for Government positions as unskilled 
laborers, you are informed that hereafter acting assistant surgeons 
on duty at marine hospitals, relief stations, quarantine stations, 



II 



69 

and immigration stations who do not devote all their time to service 
work are allowed to make the following charges for making physical 
examinations of such applicants: 

1. For the physical examination of applicants for positions as 
unskilled laborers a charge of $1 may be made. 

2. For the physical examination of applicants for positions in the 
classified civil service a charge of not more than $2 may be made. 

In each case charge for physical examinations, as mentioned above, 
is to be paid by the applicant. Provisions contained in bureau 
letters of October 6, 1915, inconsistent with the instructions are 
hereby revoked. 

Rupert Bltje, 

Surgeon General. 



Revokes Portion of Bureau Circu'ar Letter No. 77, Dated September 20, 1915. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ March 7, 1916. 

Bnrean Circular Letter No. 87. 

To medical officers of the United States Public Health Service: 

Attention is invited to Instruction No. 4 on the reverse side of 
Form 2522, United States Coast Guard, which reads as follows : 

(4) When a patient Is under the care of a medical officer or a private 
physician, a brief and comprehensive statement in duplicate on Form 
1946-a-b-c, Public Health Service, showing the patient's condition, shall be 
submitted at the end of each 15-day period to the officer vv^ho signed the request 
for the treatment. The latter shall forward this report to headquarters, and 
shall see that the necessary forms (No. 1946-a-b-c) are furnished. No portion 
of Form 1946-c need be filled in except that which shows the amount of sugar 
and albumen in the urine. 

In view of the above, that portion of Bureau Circular Letter No. 
77, dated September 20, 1915, relating to the transmission of clinical 
histories, which reads as follows : " Two copies of the clinical his- 
tories of such patients should be forwarded to the bureau every 15 
days," is hereby revoked, and in the future clinical histories of Coast 
Guard patients, which have been forwarded heretofore in duplicate 
to the bureau, will be transmitted in duplicate to the Coast Guard 
officer who signed the request for treatment. 

KuPERT Blue, 

Surgeon General. 



70 

Use of New Form of "Pay and Commutation Roll." 

Treasuet Department, 
Bureau or the Public Health Service, 

Washington^ June 7, 1916. 

Bureau Circular Latter No. 88. 

Commissioned medical officers^ United States Public Health Service, 

and others concerned : 

This circular letter supersedes Bureau Circular Letter No. 78, 
September 25, 1915. 

A new "Pay and commutation roll," Form No. 1948, has been 
issued and will hereafter be used for all pay and commutation due 
commissioned officers and pharmacists, and for no other purpose. 

Officers and stations having use for the new roll should make 
requisition on Form 1906 at once, specifying quantity desired under 
item 1948, changing the title on the requisition to read " Pay roll 
for commutation roll." 

Form 1962 and 1952-a, "Pay roll for personal s&rvices," will be 
continued in use for pay of acting assistant surgeons and all other 
employees. 

A. H. Glennan, 
Acting Surgeon General. 



Treasury Department, 
Bureau of the Public Health Service, 

Washington, June 9, 1916. 

Bureau Circular Letter No. 89. 

To commissioned medical officers, acting assistant surgeons, pharma- 
cists, and others concerned: 
The following is a copy, in part, of a letter signed by the Secretary 
of the Treasury, under date of May 26, 1916, relative to the handling 
of narcotic drugs by employees of governmental agencies : 

18. My attention has just been called to two incidents in connection with the 
enforcement of the act of December 17, 1914, which illustrates the opportuni- 
ties afforded for violation of this act by employees of governmental agencies, 
both Federal and State, exempted in their official capacity under the provision 
of this law from registration and keeping records of prescribed drugs, if some 
precautions are not taken to safeguard and restrict the drugs to the official 
purposes to which the exemptions apply. 

* * * In view of these facts, I am calling this matter to your personal 
attention that you may take such steps as are necessary to prevent these condi- 
tions, which admit of serious violation of the law, from arising in the conduct 
of those medical and scientific units of bureaus of this department under your 



71 

Immediate personal direction, and I would suggest that the officers in charge 
of the medical supplies, and particularly of the narcotic drugs, be instructed 
to have accurate record made of such drugs received and dispensed, and that 
those officially responsible for the proper use thereof be required to keep tnese 
narcotics under lock and key, and that access thereto be limited to only those 
vpho in their official capacity have legitimate use for or distribution thereof. 

In conformity with the above, officers of the service who receive 
and dispense narcotic drugs are hereby directed, first, to keep such 
drugs under lock and key ; second, that access to such drugs be limited 
to only those persons who have a legitimate right thereto in carrying 
out their official duties ; and third, that an accurate record be kept of 
all narcotic drugs received and dispensed. 

A. H. Glennan, 
Acting Surgeon General. 



Special Temporary Duty. 

Treasury Department, 
Bureau of the Public Health Service, 

W ashington^ July 11^ 1916. 

Bureau Circular Letter No. 90. 

To conimissioned medical ofjicers^ Public Health Service: 

Paragraph 182 of the Regulations of the Public Health Service ap- 
proved JVlarch 4, 1913, provides that " officers on changing stations 
may ship on Government bill of lading baggage and personal effects 
* * * in weight not to exceed 7,200 pounds." 

An officer on special temporary duty is entitled to allowance of 
quarters or commutation therefor at his proper station. Special tem- 
porary duty does not involve any change of residence and assign- 
ments of this character are usually of comparatively brief duration, 
and do not require the establishment of a new domicile. 

The baggage and personal effects of an officer on special temporary 
duty which he is permitted to carry at Government cost are therefore 
limited to the amount he is allowed to transport without extra charge 
as baggage on his railroad ticket. 

Any additional cost for packing, drayage, and transportation must 
be at the officer's personal expense, except that he may have shipped 
at Government cost any scientific books, instruments, or laboratory 
apparatus necessary to the work. 

A. H. Glennan, 
Actkig Surgeon General. 



72 

The Use of Government Telephones. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, August 2, 1916. 

Bureau Circular Letter No. 91. 

Medical officers, United States PuMic Health Service, and others 

concerned: 

You are advised that under the rules of the department Govern- 
ment telephones must not be used for private business at Government 
expense. 

A notice to this effect should be posted in a conspicuous place for 
the information of officers and employees of all stations of the 
service. 

Hereafter officers in charge should certify on the face of bills for 
telephone service that no expense in this bill has been incurred for 
private business. 

A. H. Glennan, 
Actiiig Surgeon General. 



Annual Reports. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, August 5, 1916. 

Bureau Circular Letter No. 92. 

To co7nmissioned medical officers, acting assistant surgeons, and 

others concerned: 

Your attention is called to the necessity of forwarding annual 
reports of transactions for the fiscal year ended June 30, 1916, as 
promptly as possible. 

Legislation by Congress requires the submission of annual reports 
of all Government departments and bureaus at an earlier date than 
heretofore, and it is accordingly directed that copy of annual reports 
from all stations of the service be sent to the bureau not later than 
August 20, 1916. 

A. H. Glennan, 
Acting Surgeon General. 



73 

Additional Instructions as to Reporting Changes in Personnel of the Service 
and Leaves of Absence Granted Under Authority of the Regulations. 

Treasuey Department, 
Bureau of the Public Health Service, 

Waskingto7i, August 26, 1916. 

Bureau Circular Letter No. 93. 

C oininissioned medical officers United States Puhlic Health Service 

and others concerned: 

Your attention is directed to amended Executive order dated 
October 18, 1915, exempting from examination certain employees in 
the Public Health Service, which reads as follows : 

7. In the Public Health Service. — Attendants employed at not more than $50 
per month in the United States or at any salary elsewhere ; scientific assistants 
employed temporarily for periods not to exceed six months, or longer with the 
prior approval of the commission, in investigation of contagious or infectious 
diseases and matters pertaining to the public health; and any person tempo- 
rarily employed in the work of preventing or suppressing a threatened or actual 
epidemic of any disease for which the appropriation for the prevention of 
epidemics is available. 

Bureau circular letter No. 69, dated August 17, 1915, has been 
furnished to all officers of the service whose duties require them to 
make recommendations as to the personnel. The instructions con- 
tained in this circular are still in effect, except that the amendment 
to paragraph 7, Subdivision III, schedule A, of the Civil Service 
Rules, made effective by the above Executive order, excepting from 
examination all attendants employed at not more than $50 per month, 
is now held by the Civil Service Commission to apply only to per- 
sons performing the usual duties of attendant as provided for in 
the regulations. 

In making recommendations for original appointments, a full 
statement should be made regarding the duties of the position and 
the qualifications of the persons recommended for appointment. 

Clerks, pilots, marine engineers, and female nurses must be selected 
from a list of eligibles provided by the Civil Service Commission or 
by the secretary of the civil-service district. If no eligible is avail- 
able, the approval of the district secretary should be attained, in 
writing, on the letter recommending the appointment, to the selec- 
tion outside the register. 

Cooks come within the exemptions allowed. 

In making reports of changes in the personnel of a routine char- 
acter, the resignations or termination of service of attendants should 
in all cases be reported before a recommendation is made for ap- 
pointment, and the dates should be carefully given, the date of 
separation being the last day of pay and of appointment the first 
day of x^ay. 



74 

It will be sufficient in these cases to give the designation of the 
position made vacant and to which appointment is made, and a 
detailed description of duties need not be given. 

All changes should be reported in duplicate, and a completed form, 
" Information as to the personnel," should accompany each recom- 
mendation for appointment, unless such information is already on 
file in the department. 

Reports of separation from the service should be made in all cases, 
even although the employee is serving under a limited appointment. 

Unusual designations should not be given to attendants ; the posi- 
tion of assistant pharmacist is not known to the service regulations, 
and that of assistant pilot is not recognized by the Civil Service 
Commission or Steamboat-Inspection Service. 

All leaves of absence granted under the authority of the regula- 
tions should be reported promptly at the end of each month ; leaves 
granted by the bureau or department need not be reported ; leave is 
granted for the calendar year and is not cumulative. 

Leave of absence is granted in the discretion of the head of depart- 
ments and is a privilege only and not a right. No additional ex- 
pense will be incurred at stations on account of absence of employees, 
except in special instances. 

A. H. Gleknan, 
Acting Surgeon General. 

Fees for Examination of Foreign Seamen. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ Septemher 7, 1916. 

Bnrean Circular Letter No. 94. 

Medical oificers in charge of stations^ United States Public Health 

Service : 

Your attention is directed to paragraph 126 of the regulations of 
the service which states in part as follows : 

A fee of $1 will be charged for eaeti examination of a foreign seaman, and 
fees so received will be deposited with the collector of customs in the same 
manner as donations to the marine-hospital fund. 

In order that this fee may be collected, you are directed, when a 
seaman presents himself for examination as to eyesight, hearing, and 
physical condition, to require him to furnish evidence that his last 
service as seaman was upon an American vessel, or that he in- 
tends to ship upon an American vessel. In the latter case a state- 
ment from the master or owner of the vessel to the effect that he 
wishes to ship the seaman, giving the vessel's name and nationality, 
is necessary before he can be examined free of charge. If the appli- 



75 

cant can not present the above evidence or if he intends to ship on a 
foreign vessel, a fee of $1 should be collected. 

Rupert Blue, 

Surgeon General. 



Reexamination of Officers and Men of the Merchant Marine. 

Treasury Department, 
Bureau of the Pup>lic Health Si:rvice, 

Washington, September 8, 1916. 

tfureau Circular Letter No. 95. 

Medical officers in charge United States Public Health Service: 

The local inspectors of the Steamboat-Inspection Service will be 
directed by the Inspector General, in the near future, to have all men 
desiring physical examination who have been previously rejected by 
an officer of the service reexamined by a board of officers when they 
request such reexamination. 

Boards are hereby convened at stations where there are two or 
more medical officers on duty, the senior officer chairman and the 
junior officer selected by the senior officer recorder, to examine such 
persons as may be sent before it by the local inspector. The report of 
the board should be made upon the blanks which have been previously 
used for recording the result of these examinations, and should be 
signed by both officers. In the case of rejection for color blindness a 
special statement should be appended to the report showing what 
colors the applicant confuses. To protect against substitution care 
should be exercised to see that the person presenting himself for ex- 
amination is the person who was previously rejected. Two copies of 
the report should be sent to the local inspector who requested the 
examination, one copy should be retained at the station and one copy 
sent to the bureau. 

Rupert Blue, 

Surgeon General. 

Medical Relief for Light Keepers and Assistant Light Keepers, Lighthouse 

Service. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, September 11, 1916. 

Bureau Circular Letter No. 96. 

Medical officers in charge of stations. United States Public Health 

Service: 

An act approved August 28, 1916, entitled "An act to authorize aids 
to navigation and for other works in the Lighthouse Service, and for 
other purposes," contains the following section: 



76 

Sec. 5. That hereafter light keepers and assistant light keepers of the Light- 
house Service shall be entitled to medical relief without charge at hospitals and 
other stations of the Public Health Service under the rules and regulations 
governing the care of seamen of the merchant marine : Provided, That this 
benefit shall not apply to any keeper or assistant keeper who receives an original 
appointment after the passage of this act, unless the applicant passes a physical 
examination in accordance with rules approved by the Secretary of Commerce 
and the Secretary of the Treasury. 

The benefits of this act are restricted to persons officially designated 
as light keepers or assistant light keepers. Laborers in charge of 
lights or attached to light stations are not entitled to treatment. 

In accordance with this law, you are directed to furnish medical 
relief to light keepers and assistant light keepers of the Lighthouse 
Service who were appointed before the passage of this act without 
charge, when requested by an officer of the Lighthouse Service or the 
keeper of a light station, under the regulations governing the admis- 
sion of seamen of the merchant marine. Light keepers and assistant 
light keepers appointed after the passage of this act are not entitled 
to treatment unless the applicant has passed a physical examination 
in accordance with rules approved by the Secretary of Commerce 
and Secretary of the Treasury. These rules will be promulgated in 
a few days. 

Rupert Blue, 
Surgeon General. 



Communications to the Department to be Transmitted Through the Bureau. 

Treasury Department, 
Bureau or the Public Health Service, 

W ashingto7i, October 20^ 1915. 

Bureau Circular Letter No. 97. 

To medical officers in charge^ United States marine hospitals and 

quarantine stations: 

The provisions of bureau circular letter No. 11, dated September 
17, 1913, are hereby revoked. All communications to the department 
shall be transmitted in conformity with paragraph 673 of the service 
regulations. 

Officers in charge of stations shall submit requisitions, proj)osals, 
and bills for work chargeable to funds under the control of the 
Supervising Architect to the local representative of that office for his 
information and recommendation before transmitting the papers 
through the channels prescribed by the regulations. 

Ectpert Blue, 
Surgeon General. 



77 

Fees for Examination of Foreign Seamen. 

Teeasury Department, 
Bureau or the Public Health Service, 

Washington, October 20, 1916. 

Burean Circular Letter No. 98. 

To commissioned medical officers, acting assistant surgeons, and others 

concerned: 

The medical officer on duty at an out-patient ojffice of the service 
must keep a record of all money received for conducting physical ex- 
aminations of foreign seamen and must turn this money over every 
evening when the office is closed to the medical officer in charge of the 
station, along with a memorandum giving the number of persons 
examined and the amount. 

At the end of the month, the medical officer in charge of the station 
must deposit this money with the collector of customs and obtain a 
receipt therefor. 

Rupert Blue, 

burgeon General. 



Responsibility for Patients' Money and Other Valuables. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, October 20, 1916. 

Bureau Circular Letter No. 99. 

To m^edical officers in charge United States marine hospitals : 

Paragraph 486 of the regulations of the service, 1913, requires that 
upon the admission of a patient for treatment, the medical officer in 
charge of the marine hospital will receive his money and other val- 
uables and give a receipt therefor, and upon the termination of the 
treatment of the patient, his money and other effects shall be returned 
to him and the receipt taken up and filed. 

It has been ascertained that at some of the marine hospitals the 
medical officers in charge have delegated this responsibility to junior 
officers. The bureau does not approve of this practice. The medical 
officer in charge should receive the patients' money and other valu- 
ables and should himself return them to the patients. Under no cir- 
cumstances should money or other valuables be received by an at- 
tendant, neither should an attendant be sent to get money or other 
valuables from a patient nor should these articles be sent to a patient 
by an attendant. When the medical officer in charge of a marine hos- 
pital is away, the money and other valuables of patients should be 
received by the medical officer in temporary charge, who should turn 



78 

over to the former as soon as he returns to the station all patients' 
property received during his absence. 

When a patient in a marine hospital becomes seriousl}^ ill or dies, 
his bedding and clothing should be searched in the presence of the 
medical officer in charge of the ward, who will immediately turn 
over to the medical officer in charge of the hospital all money or other 
valuables that may be found. 

The medical officer in charge of a marine hospital will be held 
strictly responsible for all money and other valuables placed in his 
charge for safe-keeping, either directly or through an officer in tempo- 
rary charge, and will be expected to make good the loss thereof. 

The provisions of paragraph 486 of the Regulations, as construed 
by this circular, shall be rigidly adhered to. Any disregard thereof 
will be considered a violation of the Regulations and will be followed 
by action governing such cases. 

Rupert Blue, 

Surgeon General. 

Safeguards to be Observed in Performing Fumigation with Hydrocyanic 

Acid Gas. 

Treasuet Department, 
Bureau of the Public Health Service, 

Washington^ November ^, 1916. 

Bareau Circular Letter No. 100. 

To o fleers of the TJ . S. Public Health Service: 

1. ^¥hen a vessel is fumigated with cyanide gas, no one shall be 
permitted to enter the various compartments of the ship until entry 
to such space is declared safe by the medical officer in charge. 

2. Subsequent to opening hatches, companionways, and ports, not 
less than 15 minutes shall elapse before anyone sl^iall enter the 
superstructures, such as staterooms, cabins, saloon, or forecastle, and 
not less than one hour before entering the holds. This is the mini- 
mum, and the time will be prolonged according to the discretion of 
the officer in charge. 

3. If artificial means for ventilation, such as blower or fan, are 
not available, wind sails shipped into place should be utilized for 
aeration of holds. 

4. Before declaring it safe to enter holds, a captive animal (guinea 
pig, rat, cat, etc.) shall be lowered and exposed to the aerial content 
of such compartments, and the effects produced, if any, shall be a 
guide in estimating the amount of gas present in dangerous quantity. 

5. After measures have been taken to free compartments of cya- 
nide fumes, and the application of test by captive animal indicated 
sufficient dissipation of the gas to make entering the compartments 



79 

a safe procedure, they should be entered in all parts by one of the 
fumigators or by the oiScer himself. This shall be done as a final 
step before the officer declares the vessel safe to be entered by the 
personnel connected with the vessel. 

6. Decision as to safety of entering compartments shall be made 
by the officer in charge of the fumigation and on board the vessel 
concerned; but during the interval between the sealing of compart- 
ments undergoing fumigation and the time appointed for determin- 
ing the safety of entering, the officer may designate a trustworthy 
employee, or employees, to attend to the opening up of compart- 
ments, the supervising of installation of blower or windsail, and the 
prevention of any persons entering compartments before permis- 
sion of the officer in charge. 

7. The provisions of Bureau Circular No. 79, of 1915, shall be re- 
viewed and the safeguards mentioned therein shall be observed in 
addition to the foregoing. 

8. You will acknowledge receipt hereof. 

HuPERT Blue, 

Surgeon General. 

Record of Articles of Subsistence Drawn by Pharmacist. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ Decemher ^, 1916. 

Burean Circular Letter No. 101. 

Commissioned medical officers, acting assistant surgeons, pharma- 
cists, and others concerned : 

You are informed that hereafter a special record must be kept in 
a subsistence storeroom book of articles drawn by the pharmacist in 
accordance with the ration specified in Amendment No. 3 to the 
regulations of the service, 1913, dated June 19, 1914. 

A. H. Glennan, 
Acting Surgeon General. 

Discontinue the Use of Heroin. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, Decemher 2, 1916. 

Bnrean Circular Letter No. 102. 

C ommissioned medical officers, acting assistant surgeons, and others 

concerned : 

In view of the fact that the great increase in the use of heroin 
at present constitutes a considerable menace to public health in the 



80 

United States, it is desired to set an example and to signalize to the 
general public the danger which may accrue from its use. Heroin 
as a palliative in certain respiratory affections serves no purpose 
which can not be accomplished by other agents fully as effectively 
and without the attendant possibility of grave disaster. 

You are therefore directed to discontinue dispensing heroin and 
its salts at relief stations of the service and to send all the stock 
of these drugs now on hand to the Purveying Depot, 1414 Pennsyl- 
vania Avenue NW., Washington, D. C, either by parcel post or by 
freight on Government bill of lading. 

Rupert Blue, 

burgeon General. 



Articles or Supplies of Inferior Quality. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, December 13, 1916. 

Bureau Circular Letter No. 103. 

C onimissioned medical officers, acting assistant surgeons, and others 

concerned: 

When any articles or supplies received from the Purveying Depot 
or direct from a contractor are found upon examination to be defec- 
tive, of poor quality, or not conforming to specifications, you are 
directed not to use the articles or suj^plies unless absolutely necessary, 
but notify the contractor, if ordered by you, or the Purveying Depot, 
if ordered from there, of the defect, inferior quality, or failure to 
comply with the specifications. 

When a letter of this character is written to a contractor he should 
be told that the supplies are held subject to his order, and be 
requested to substitute therefor others that do conform to the speci- 
fications. A copy of said letter should be sent to the bureau. 

Rupert Blue, 

Surgeon General. 

Consultants to Marine Hospitals. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, Decemher 22, 1916. 

Bureau Circular Letter No. 104. 

To medical officers in charge United States 7narine hospitals : 

Inasmuch as it is important that the patients of the service receive 
the best special treatment obtainable, and as it is impossible for every 



81 

medical officer of the service to be a specialist in all branches of medi- 
cine and surgery, you are directed to communicate with specialists 
residing in your city and inquire if any of them would be willing to 
serve without pay as consultants to the marine hospital at your sta- 
tion, forwarding to the bureau the names and addresses of those who 
are desirous of accepting such positions. 

Upon receipt of the names of these physicians the bureau will rec- 
ommend to the department that they be given an appointment for 
one year, with the understanding that they shall call at the hospital 
whenever requested to consult with you about the condition of cer- 
tain patients under your charge with a view to determining the best 
form of treatment to employ, and to perform or assist in the per- 
formance of such operations as come within their particular specialty. 

It may be mentioned to these physicians that, if appointed, they 
will have the privilege of stating on their letterheads, title pages 
of any articles or books they may publish, etc., the fact that they are 
consultants to marine hospitals controlled by the United States Pub- 
lic Health Service. 

Rupert Blue, 

Surgeon General. 

Approved : 

B. R. Newton, 

Assistant Secretary. 



Amends Portion of Bureau Circular Letter No. 97. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ February 6, 1917. 

Bnrean Circular Letter No. 105. 

To medical officers in charge United States marine hospitals and 

quarantine stations: 

The second paragraph of Bureau Circular Letter No. 97, dated 
October 20, 1916, entitled " Communications to the department to be 
transmitted through the bureau," is hereby amended to read as fol- 
lows : 

Officers in charge of stations in localities where a representative of 
the Supervising Architects's Office is permanently located shall sub- 
mit to such representative for his opinion as to practicability, neces- 
sity, or value all proposals obtained for supplies, repairs, changes in 
construction, or mechanical equipment, exceeding; $iOO in value, which 
are paid for out of funds under the control of the Supervising Archi- 
tect. All papers, etc., in connection with such matters, will be re- 
turned to the custodian b}^ such local representative to be transmitted 
14330°— 21 6 



82 

by him through the bureau in accordance with existing regulations. 
Proposals for items of the above character of less than $100 >in value 
shall be transmitted through the bureau direct in the usual manner. 
Vouchers in payment for all work chargeable to appropriations under 
the control of the Supervising Architect shall be prepared and certi- 
fied to by the custodian in accordance with section 12 of the " Instruc- 
tions to Custodians of Public Buildings " and need not be submitted 
to the local representative unless specifically directed to do so. 

Rupert Blue, 
burgeon General. 



Income Tax Return for Value of Quarters. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, February 13^ 1917. 

Bnreau Circular Letter No. 106. 

Medical officers, United States Public Health Service, and others 

concerned: 

Your attention is invited to the following letter from the Deputy 
Commissioner of Internal Revenue, Treasury Department, dated 
February 2, 1917, addressed to the Surgeon General, relative to the 
income tax : 

This office acknowledges the receipt of your letter of January 17, 1917, and in 
reply you are advised that where an officer or employee of the Federal Gov- 
ernment is furnished living quarters in addition to a salary, the rental value of 
such quarters is regarded as compensation subject to the income tax, as may be 
seen upon reference to Treasury Decision 2079, a copy of which is inclosed 
herewith, which decision was issued under the provisions of the act of October 
3, 1913, but is also applicable under the provisions of the Federal income tax 
law of September 8, 1916. 

Treasury Decision N"o. 20Y9, dated November 24, 1914, referred 
to above, under income tax liability, states that the commutation of 
quarters and the money equivalent of quarters furnished in kind 
shall be returned as income. Under this decision officers occupying 
quarters at marine hospitals and quarantine stations will include in 
the income tax returns the value of furnished quarters they occupy 
as fixed by the amount of commutation they would receive in lieu of 
quarters. 

For any further information regarding the income tax, inquiry 
should be made of the collector of internal revenue in the district in 
which the return is made. A copy of Treasury Decision No. 2079 is 
herewith inclosed. 

Rupert Blue, 
Surgeon General, 



83 

Fees for Professional Services to Beneficiaries. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, March 15, 1917. 

Burean Circular Letter No. 107. 

To Gomnnissioned medical officers, acting assistant surgeons, and 

others concerned : 

Your attention is called to paragraph 129 of the service regula- 
tions, 1913, which reads as follows : 

129. No fee will be charged by any officer of the Public Health Service for 
the medical examination or professional treatment of seamen of the United 
States merchant marine or for making a certificate as to their physical condi- 
tion, and no officer shall accept a fee for professional service relating to the 
public service, except acting assistant surgeons appointed for physical examina- 
tions only. 

As long as jou are an officer of the Public Health Service^no charge 
shall be made by you under any circumstances for professional serv- 
ices to officers or seamen on American vessels or to other beneficiaries 
of the service. The bureau can not permit its officers to receive fees 
for the treatment of seamen, as otherwise all sorts of excuses would 
be made by officers giving reasons why they had charged such patients 
for treatment. 

No officer shall act in his official capacity as a private physician to 
a seaman, and if the latter requests him to do so, it will be necessary 
for the officer to inform the seaman that he is not permitted to receive 
a fee for such service. 

The reason for the issuance of this circular at the present time is 
on account of workmen's compensation acts that have been passed by 
a number of States. Many transportation companies are insuring 
their employees against accident because of these acts, in accordance 
with the agreement between the transportation and insurance com- 
panies. The latter agree to pay for all necessary treatment for the 
first 14 days or more after the accident. As provided by their con- 
tracts, the insurance companies have in a number of instances offered 
to pay officers of the service for medical treatment furnished injured, 
seamen, also to pay their hospital expenses, not being aware that the 
Government provides for such care and treatment. 

In these cases the insurance companies should be informed that in- 
jured seamen are entitled to treatment at relief stations of the service 
and that there is no charge either for the services of the medical officer 
or for hospital expenses. 

Bupert Blue, 
Surgeon General. 



84 

Treasury Department, 
Bureau or the Public Health Service, 

Washi?igto?i, March 19, 1917. 

Bureau Circular Letter No. 108. 

To conimissioiied medical oficers, acting assistant surgeons, and 

others concerned: 

Your attention is directed to paragraph 6 of Circular Letter No. 
IT, dated September 20, 1916, issued by the United States Coast 
Guard, which reads as follows : 

6. Where there is a medical officer attached to a cruising cutter vaccinations 
shall be performed by him. Where there is no medical officer attached the com- 
manding officer shall arrange with the medical officer of- the Public Health 
Service if there be one at the vessel's headquarters or with the officer in charge 
of a hospital or a relief station of that service on the vessel's station to perform 
the required vaccination. If the vessel is required to leave port after the first 
injection against typhoid fever has been administered to a person the command- 
ing officer sRall arrange to leave such person on a harbor cutter at the vessel's 
headquarters. If there be no harbor vessel available the commanding officer 
shall arrange to leave the person at a marine hospital of the first class during 
the absence of the vessel if the vessel is to be absent on the date that another 
injection is to be administered ; but any person so left in hospital shall imme- 
diately report on board upon the vessel's first return to port. 

When a warrant officer or enlisted man of the Coast Guard who 
is not in need of hospital care is sent to a marine hospit 1 in order 
to be vaccinated against typhoid fever and there is no Coast Guard 
vessel in harbor, a voucher shall be prepared to reimburse the Public 
Health Service for the expense of such care during the time that he 
is in the hospital. The rates should be the same as those stated in 
T. D. 36469, dated June 8, 1916, for the accident because of these acts, 
and, in accordance with the agreement between the transportation 
and insurance companies, the latter agree to pay for all necessary 
treatment for the first 14 days or more after the accident. As pro- 
vided by their contracts, the insurance companies have in a number 
of instances offered to pay officers of the service for medical treat- 
ment furnished injured seamen, also to pay their hospital expenses, 
not being aware that the Government provides for such care and 
treatment. 

In these cases, the insurance companies should be informed that 
injured seamen are entitled to treatment at relief stations of the 
service and that there is no charge either for the services of the 
medical officer or for hospital expenses. 

Rupert Blue, 
Surgeon General. 



85 

Executive Order. 

Treasury Department, 
Bureau of the Public Health Service, 

Washingtoti, April 6, 1917. 

Bureau Circular Letter No. 109. 

Commissioned medical o-fficers^ United States Public Health Service, 
and others concerned: 
Your attention is directed to the following Executive order : 

Under the authority of the act of Congress, approved July 1, 1902, and sub- 
ject to the limitations therein expressed, it is ordered that hereafter in times 
of threatened or actual war the Public Health Service shall constitute a part 
of the military forces of the United States, and in times of threatened or actual 
war, the Secretary of the Treasury may, upon request of. the Secretary of War 
or the Secretary of the Navy, detail officers or employees of said service for 
duty either with the Army or the Navy. All the stations of the Public Health 
Service are hereby made available for the reception of sick and wounded offi- 
cers and men, or for such other purposes as shall promote the public interest 
in connection with military operations. 

WooDBow Wilson. 
The White House, 

April 3, 1917. 

Rupert Blue, 
Surgeon General. 



Oath of Allegiance. ^ 

Treasury Department, 
Bureau of the Public Health Service, 

IVashington^ April 10^ 1917. 

Bureau Circular Letter No. 110. 

Commissioned medical officers United States Public Health Service 

and others concerned: 

You are informed that all medical officers and employees of the 
Public Health Service who have not already done so should take the 
oath of allegiance to the United States. 

You are, therefore, directed to have such employees under your 
charge execute this oath in duplicate (Form 2222, oath of office) and 
to forward both copies to the bureau as early as possible. 

Rupert Blue, 
Surgeon General. 



86 

Amends Bureau Circular Letter 105. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ April 24-, 1917. 

Bnrean Circular Letter No. 111. 

To medical officers in charge United States marine hospitals and 
quarantine statioTis: 

1. In order to more fully harmonize bureau regulations with those 
of the Siiper vising Architect, with respect to the repairs and pres- 
ervation of public buildings of the service. Bureau Circular Letter 
No. 105, dated February 8 is hereby revoked and the following in- 
structions given: 

2. All communications to the department shall be transmitted in 
conformity with paragraph 675 of the service regulations. 

3. Officers in charge of stations at Boston, Mass. ; New York, N. Y. ; 
Charleston, S. C. ; and San Francisco, Calif., hereafter, before taking 
action in connection with repairs or for supplies to be used in connec- 
tion therewith, which are to be paid for out of funds under the con- 
trol of the Supervising Architect, or incurring any expense on account 
thereof, shall present such requisitions to the local representative of 
the Supervising Architect, who is permanently located at the above-, 
named places, for his recommendation, and who shall then, upon the 
approval of the Supervising Architect, take proposals thereon, return 
them to the ftiedical officer in charge, with his indorsement, to be 
transmitted to the bureau. 

4. When the services of a representative of the aforenamed offices 
are not available and the delay in securing same would result in 
damage to the Government property, the medical officer should act as 
provided for under Section XIII of instructions to custodians, with 
the statement that such services were not available and why. 

5. In case of minor repairs or materials required therefor, the esti- 
mated cost of which is less than $100, requisition should be submitted 
to the local representative of the Supervising Architect, who is hereby 
authorized to proceed with the taking of proposals for same, if ap- 
proved by him ; the bids to be forwarded through the bureau as above 
provided for, 

6. If requisitions presented to representatives of the Supervising 
Architect at the above-named stations are not approved, the bureau 
should be so informed. 

7. Medical officers in charge of all other stations shall secure au- 
thority from the Supervising Architect through the bureau before 
soliciting proposals or incurring any expense in connection therewith, 
where the estimated cost exceeds $100, except for emergency expendi- 



87 

tures, when they shall be guided by Section XIII of instructions to 
custodians; for less amounts they may proceed to take proposals 
without special authority and submit them through the bureau as 
above provided for. 

8. All vouchers for expenditures as above indicated shall be issued 
as provided for in instructions to custodians and forwarded to the 
Supervising Architect through the bureau. 

9. This order has been approved by the Supervising Architect as 
to practice involved and instructions to his representatives in secur- 
ing and approving proposals for the stations named in paragraph 8 
and copies hereof will be forwarded them through the Supervising 
Architect. 

Rupert Blue, 
Surgeon General. 

Filling in Block Spaces on Transportation Requests. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ April 28, 1917. 

Bureau Circular Letter No. 112. 

To medical officers and employees, United States Public Health Serv- 
ice ; 

In order to secure uniformity in filling in the hlock spaces on Treas- 
ury Department transportation requests the instructions herewith 
must be followed. 

1. Transportation. — When transportation only is secured, the char- 
acter of accommodations furnished should be stated in the upper 
space under the word " Class " as first, second, or third. Figures 
showing the exact number of persons securing transportation should 
be placed in the space under the words " Number of persons." 

2. Sleeping-car accommodations. — When sleeping-car accommoda- 
tions are secured, figures showing the actual number of berths ob- 
tained should be placed in the blank spaces under "Upper" or 
" Lower," " Standard," or " Tourist," as the case may be. Do not 
give the car number of the berth. The spaces under the word " Trans- 
portation " are not to be used in this case. 

3. Seat. — When seats are obtained, figures in the space under the 
word " Seats " should be used to show the number of seats occupied. 

4. Stateroom. — When a stateroom is secured, only the space under 
the word " Stateroom " is to be used. When a stateroom is furnished 
in connection with water transportation, the name of the vessel, and 
the number, location, or price of the stateroom must be stated in the 
lower space. 



88 

5. Mileage or commutation l)ooks. — When a request is used to se- 
cure mileage books or multiple trip tickets, the number of the book 
should be entered in the lower space of the blocks on the request. 

6. Any information in regard to services rendered in addition to 
that on face of the request should be given under paragraph 2 on the 
reverse of the request over the signature of the traveler, 

7. Care must be exercised that the correct name of the company 
or corporation furnishing the transportation is used. Nicknames or 
colloquial designations must be avoided. 

8. All the block spaces not used should be crossed out either by 
" X " or by a line drawn through those spaces. 

Rupert Blue, 

Surgeon General. 

Vaccination Against Typhoid Fever. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, May 31, 1917. 

Burean Circular Letter No. 113. 

To commissioned medical officers, acting assistant surgeons, and 

others concerned: 

All officers at present on duty, or who may hereafter receive a com- 
mission or appointment in the service, are directed to have themselves 
vaccinated against typhoid fever within one month after the receipt 
of this letter or within one month after being placed on duty, unless 
they have had this disease, have been previously vaccinated against 
it, or are over 55 years of age. Antityphoid vaccine may be obtained 
by sending a requisition to the Director of the Hygienic Laboratory, 
Washington, D. C. 

A form similar to the inclosed should be prepared and forwarded 
to the bureau by each officer, if he has not already done so. 

The receipt of this letter should be promptly acknowledged. 

Rupert Blue, 

Surgeon General. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, June 12, 1917. 

Bureau Circular Letter No. 114. 

To commissioned medical officers, acting assistant surgeons of the 
United States Puhlic Health Service, and others concerned : 
In accordance with section 21 of the act of September 7, 1916, pro- 
viding compensation to civil employees of the United States injured 



while in the performance of their duty, and at the request of the 
United States Employees' Compensation Commission, commissioned 
medical officers and acting assistant surgeons are hereby directed to 
act as referees in compensation cases in which there is a dispute 
between the claimant or his attending physician on the one hand 
and his official superior or the medical officer stationed at his place 
of employment on the other hand, as to the cause, nature, character, 
and extent of the disability in question. No examination in the 
capacity of referee should be made except upon the request of the 
injured employee's official superior or the United States Employees' 
Compensation Commission. 

When such examinations are made the injured employee may be 
accompanied by his own physician, who may participate in such 
examination if he so desires. Likewise, if it is desired by the em- 
ployee's official superior, he or some representative designated by 
him may be present and participate in the examination by the ref- 
eree. Great care should be exercised in all examinations by referees 
to weigh carefully and with absolute impartiality all evidence sub- 
mitted by either side to the controversy, and the referee must feel 
free to express his impartial judgment in each case. It is to be un- 
derstood that referees are under no circumstances to consider them- 
selves as representing the interests of the United States as against 
the interests of the injured employees, but are to arrive at a fair 
and impartial decision in each case. 

If in any such cases there is a doubt as to the proper conclusion 
to be reached by the referee, the injured employee should be admit- 
ted to the hospital under charge of such referee for observation and 
treatment until such time as a definite decision can be reached. 
. At contract stations of the service vouchers should be made up in 
accordance with contract rates, but chargeable to the " Employees' 
compensation fund," and forwarded to the United States Employees' 
Compensation Commission through the bureau ; vouchers for charges 
for X-ray examination and other unusual expenditures necessary to 
the examination should be made up and forwarded in the same 
manner. Reimbursement for necessary traveling expenses will be 
made from funds under the control of the United States Employees' 
Compensation Commission. 

Requests to act as medical referee will be addressed to the med- 
ical officer in charge of the service at the port, who may act as 
referee himself or detail a junior medical officer serving under him 
to act in this capacity. Reports of examinations should be signed 
by the medical officer making them, and should be addressed to the 
United States Employees' Compensation Commission. If examina- 
tion is made by a junior officer, report of same should be forwarded 
through the medical officer in charge of the station. 



90 

In addition to filling out the form " Physician's report on condi- 
tion of injured employee," to be supplied by the United States Em- 
ployees' Compensation Commission, a careful examination should 
be made in accordance with instructions given on clinical report 
Form 1946a, issued by the Public Health Service. This examination 
should include the whole body, and any injuries, defects, or abnor- 
malities observed, in addition to that complained of, should be noted 
in report of examination, for the reason that such reports may be 
required in future years in the settlement of claims for injuries re- 
ceived while in the service of the Government. A complete record 
of such examinations should be prepared on clinical history Forms 
A, B, and C of the Public Health Service, and the same forwarded 
to the medical officer of the United States Employees' Compensation 
Commission, through the bureau. 

Rupert Blue, 

Surgeon General. 



Tkeasurt Department, 
Bureau of the Public Health Service, 

Washington, June 27, 1917. 

Bureau Circular Letter No. 115. 

To co^ntnissioned medical officers, acting assistant surgeons, customs 

officers, and others concerned : 

Section 9 of act of Congress approved September 7, 1916, entitled 
"An act to provide compensation for employees of the United States 
suffering injuries while in the performance of their duties, and for 
other purposes," reads as follows : 

Sec. 9. That immediately after an injury sustained by an employee while in 
the performance of his duty, whether or not disability has arisen, and for a 
reasonable time thereafter, the United States shall furnish to such employee 
reasonable medical, surgical, and hospital services and supplies unless he re- 
fuses to accept them. Such services and supplies shall be furnished by United 
States medical officers and hospitals, but where this is not practicable shall be 
furnished by private physicians and hospitals designated or approved by the 
commission and paid for from the employees' compensation fund. If necessary 
for the securing of proper medical, surgical, and hospital treatment, the em- 
ployee, in the discretion of the commission, may be furnished transportation at 
the expense of the employees' compensation fund. 

The commission referred to above has been created and is known 
as the " United States Employees' Compensation Commission." This 
commission has immediate jurisdiction over matters pertaining to 
the medical and surgical relief of Government employees who are in- 
jured while in the performance of their duties. 

In accordance with the provisions contained in the above-quoted 
section of the act of Congress approved September T, 1916, civil em- 



91 

ployees of the United States who are injured while in the perform- 
ance of their duties shall be furnished, upon application and without 
personal charge, reasonable medical and surgical treatment by all 
medical officers at first, second, and third class relief stations of the 
service, in accordance with rules hereinafter prescribed : 

1. An injured civil employee of the United States in order to re- 
ceive treatment shall present to the medical officer a certificate stat- 
ing that he is a Government employee and that he was injured on a 
certain date while in the performance of his duties. Such certificate 
must be signed by the employee's superior officer, or by the medical 
officer, United States Employees' Compensation Commission. 

2. An injured civil employee of the United States in order to ob- 
tain the benefits of the service must apply in person (or by proxy if 
too seriously injured so to do) at the local office of the Public Health 
Service, or to a medical officer of said service. 

3. At marine hospitals no charge shall be made for services or sup- 
plies furnished injured civil employees of the United States. Ex- 
penditures incurred at said hospitals for the care and treatment of 
such injured employees are payable from a^Dpropriations for the 
Public Health Service. 

4. At second and third class relief stations of the service expendi- 
tures incurred on account of either office or hospital treatment fur- 
nished injured civil employees of the United States shall be taken 
up in special vouchers rendered against the United States Employees' 
Compensation Commission. The rates charged for the care of sea- 
men, as approved by the department, shall be charged for the care 
of inj^red Government employees at all contract hospitals of the 
service, and vouchers for such care should be rendered against the 
above-named commission. All vouchers for services or supplies fur- 
nished in the treatment of said injured employees will be paid direct 
by the United States Employees' Compensation Commission, and 
such vouchers should be forwarded to the bureau for reference to the 
proper officer of that commission, unless otherwise instructed. In 
preparing said vouchers, the words " Employees' compensation fund " 
should be written in at the station after the word "Appropriation " 
appearing on voucher forms, and stubs attached to such vouchers 
should be altered to show that payment is made on account of the 
United States Compensation Commission. Until further notice, 
vouchers for said services or supplies should be rendered on blanks 
issued by the Public Health Service Forms 1926 and 1949. Expendi- 
tures payable from the above-mentioned fund should not be listed 
among the expenditures noted in monthly schedules of encumbrances, 
Form 1955. No charges shall be made for professional services fur- 
nished said injured employees by medical officers of the service, nor 
shall any charge be made for supplies in stock furnished such persons. 



92 

5. Treatment furnished injured employees of the United States^ 
in accordance with the above-mentioned act of Congress, shall be 
taken up in monthly reports of patients admitted to and discharged 
from hospital treatment at first and second class relief stations, and 
relief certificates and hospital permits shall be issued in case of treat- 
ment furnished such patients at third-class relief stations of the 
service. On such reports the class of patient should be designated 
or shown and authority for said treatment should be cited as "Act 
of September 7, 1916." Treatment furnished said patients shall 
also be taken up in " Medical officer's monthly report of relief, Form 
1922," and in annual reports of medical and surgical relief furnished 
office and hospital patients, Forms 1923, 1924, and 1925. 

6. Upon termination of both office and hospital treatment, a copy 
of the clinical record of treatment furnished injured employees of 
the United States shall be forwarded, through the bureau, to the 
medical officer, United States Employees' Compensation Commission. 
Such clinical records shall include the history, diagnosis, treatment, 
and other pertinent information connected with each case, and shall 
be prepared on service forms 1946 A, B, C, and D. 

7. When it is in the interest of economy and to the welfare of 
injured emploj^ees of the United States, the above-mentioned com- 
mission will order the transfer of such patients from one station to 
another, including authority for the necessary expenses involved in 
such transfers. No injured employee should be so transferred with- 
out special authority from the United States Employees' Compensa- 
tion Commission. Upon the transfer of an injured employee from a 
second or third class relief station to a marine hospital, for the pur- 
pose of receiving further treatment, a copy of the clinical record 
should be forwarded to the medical officer in charge of said marine 
hospital; and upon discharge of said employee from the marine 
hospital a complete clinical record (covering his treatment at both 
the contract relief station and marine hospital) shall at once be for- 
warded, through the bureau, to the medical officer. United States 
Employees' Compensation Commission. 

Officers in charge of second and third class relief stations are 
directed to obtain letters signed by the proper authorities of the 
local contract hospitals to the effect that civil employees of the 
United States, injured while in the performance of their duties, will 
be received at said hospitals and furnished quarters, subsistence, 
nursing, and necessary medicines, during the fiscal year ending June 
30, 1918, at the same rates as named in their proposals submitted for 
the care of seamen during said fiscal year, the services to be the same 
as that furnished seamen. These letters should be addressed to the 



93 

chairman, United States Employees' Compensation Commission, 
Washington, D. C. They should be obtained without delay and 
forwarded through the bureau. 

Receipt of this circular should be acknowledged. 

Rupert Blue, 

Surgeon General. 

Five and Ten Per Cent Increase of Compensation. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, July 6, 1917. 

Barean Circular Letter No. 116. 

Medical officers in charge, United States Public Health Service, 
and others concerned: 

1. Section 2 of the sundry civil act approved June 12, 1917, pro- 
vides during the fiscal year 1918 increased compensation at the rate 
of 10 per cent per annum to employees who receive salaries at a 
rate per annum less than $1,200 and for increased compensation at 
the rate of 5 per cent per annum to employees who receive salaries 
at a rate not more than $1,800 per annum and not less than $1,200 
per annum. 

2. The increase applies to every appointee under the United States 
Public Health Service (medical or other officers and all other em- 
ployees) receiving compensation at the rate of $1,800 per annum or 
less, whether on an annual, monthly, or per diem basis, in the service 
on and after July 1, 1917, or employed at any subsequent date during 
the fiscal year ending June 30, 1918. 

3. The computation for the increase should be made on the amount 
of the regular compensation due for the period of service rendered. 
For instance, a person holding a position at $600 per annum or the 
equivalent, $50 per month, and who works 15 days will be paid 
$27.50; $1,200 per annum or $100 per month, for 15 days $52.50; 
$1,800 per annum or $150 per month, for 15 days $78.75. If during 
the year an appointee is promoted or demoted, the computation for 
the increase or decrease will be made to cover the old salary and the 
new. For instance, a person working July 1 to December 31 at $900 
per annum would be entitled to the increase at the rate of 10 per cent 
on the pay for the first half of the fiscal year and at the rate of 5 
per cent for the remainder of the year. 

4. A per diem appointee receiving compensation at a rate less 
than $3.33^ per day will be entitled to the 10 per cent increase, and 
if the rate is not less than $3.33^ per day and not more than $5 per 
day will be entitled to the 5 per cent increase, and if more than $5 
per day will not be entitled to any increase. 



94 

5. Computations to determine the correct increase to be paid phar- 
macists will be made on the annual compensation, including longevity 
pay but excluding commutation, 

6. No new oath is required of those persons receiving the increased 
compensation. 

7. A new form of pay roll is now in print, to show as separate 
items regular, increase, and total compensation. A supplemental 
requisition of Form 1906 should be mailed to the bureau at once 
for a supply of the new form, being particular to modify the requisi- 
tion so that the item "Pay roll" will read Form No. 1952b and 
"Pay roll (constitution sheet)," Form No. 1952c. No. 1952c will 
not be necessary at stations having less than 12 names on the roll. 
Acting assistant surgeons, heretofore taken up on a separate roll, 
will continue to be so carried on the new form. The remarks and in- 
structions for preparation of the roll printed thereon, both face 
and back, should be carefully read and exactly followed. 

8. The use of Form Nos. 1952 and 1952a will be discontinued en- 
tirely for services rendered during the fiscal year ending June 
30, 1918. 

9. Form No. 1948 will be continued in use for pay and commu- 
tation of commissioned officers and pharmacists. The 5 and 10 per 
cent increases due pharmacists will be taken up thereon as a sepa- 
rate item from the regular compensation and be included in the total 
of the roll by writing " Increase compensation at — per cent " imme- 
diately under the name of each pharmacist, the increase to be entered 
in the pay column directly under the regular pay, the total for each 
pharmacist, including commutation, whenever there is such, to be 
extended in the amount due column. 

Rupert Blue, 

Surgeon General. 

Treasury Department, 
Bureau of the Public Health Service, 

'Washington^ July 12^ 1917. 

Bureau Circular Letter No. 117. 

To Gomtnissioned medical cfficers and acting assistant surgeons^ 

United States Public Health Service: 

You are directed, when requested by the proper officer, to make 
physical examinations of persons who desire to enroll in the naviga- 
tion and engineering schools to be established by the United States 
Shipping Board. The examination should be conducted in accord- 
ance with the instructions on the back of the blank for the examina- 
tion of able seamen (Form 983, Steamboat-Inspection Service) and a 
report of each examination should be made on this blank, the blank 
being altered as may be necessary. 



95 

You are also directed, upon the request of a superintendent of one 
of these schools, if such is established at your port, to deliver a short 
lecture on maritime quarantine to the students at such time as may 
be arranged between the superintendent and yourself, explaining the 
procedure required of vessels passing through quarantine and the 
Ee^ulations of the Public Health Service on this subject. 

EupERT Blue, 
Surgeon General. 



Amending Bureau Circular Letter No. 117. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ August 23, 1917. 

Bureau Circular Letter No. 118. 

To commissioned medical o'fficers and acting assistant surgeons, 

United States Public Health Service: 

The first paragraph of Bureau Circular Letter No. 117, dated July 
12, 1917, relative to making physical examinations of persons vv^ho 
desire to enroll in the navigation and engineering schools to be estab- 
lished by the United States Shipping Board, is hereby amended by 
striking out the words " The examination should be conducted in 
accordance with the instructions on the back of the blank for the 
examination of able seamen (Form 983, Steamboat-Inspection Serv- 
ice) and a report of each examination should be made on this blank, 
the blank being altered as may be necessary," and substituting in 
lieu thereof the following : 

The examination sliould be made only for vision, color sense, and hearing, 
and the result should be recorded on Form 954 (Steamboat-Inspection Service), 
the blank being altered as may be necessary. No fee should be charged for 
this service. 

A. H. Glennan, 
Acting Surgeon General. 



Reporting Outbreaks of Epidemics. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, Septemher 6, 1917. 

Bureau Circular Letter No. 119. 

Instructions for officers of the Public Health Service detailed to 

investigate reported outbreaks or epidemics: 

Paragraph 745 of the service regulations applies to officers detailed 
to investigate outbreaks of disease in the same way and to the same 
extent that it does to officers at regular stations. 



96 

Officers detailed to investigate outbreaks of disease will within 
48 hours after their arrival in the locality of the outbreak report to 
the Surgeon General by telegraph such available data as there may 
be at the time, giving by localities involved, (1) the time of the 
beginning of the outbreak, (2) the total number of cases reported 
since the beginning of the outbreak, (3) the number, or probable 
number, of cases which have occurred during the preceding seven 
days. 

The following is a sample telegram giving this information : 

Typhoid fever began Carson City May five, Smithville June two, Perry Town- 
ship June twenty -five; total cases from beginning, Carson City fifty-six, Smith- 
ville thirty-one, Perry Township nine; week ended June twenty-nine, Carson 
City nine cases, Smithville five. Perry Township two. 

Weekly reports of the progress of the outbreak will be made 
thereafter by telegram or mail so as to reach the bureau not later 
than Tuesday. These reports Avill give (1) the total number of 
cases and of deaths reported from the beginning of the outbreak to 
the preceding Saturday night, and (2) the number of cases of deaths 
due to the disease reported during the week ended Saturday night. 

Upon finishing the investigation or leaving the vicinity of the 
outbreak, a report will be made giving a summary statement of 
(1) the cases and deaths reported by weeks by localities involved, 
and (2) the population of the locality or localities involved. 

These reports are for the information of the bureau and for use in 
the Public Health Reports and when made by letter will be briefed 
"Morbidity reports." 

You are requested to acknowledge the receipt of this letter. 
Eespectfully, 

Rupert Blue, 

Surgeon General. 



Relative to the Examination and Treatment of Persons Who Have Been 
Rejected for Military Service on Account of Curable Conditions. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, Noveniber 2J{., 1917. 

Bureau Circular Letter No. 120. 

To the commissioned medical officers and acting assistant surgeons : 

The bureau desires that you communicate with the chairmen of 
boards convened for the examination of recruits in your district and 
inform them that you are willing to furnish advice, including a pre- 



97 

scription, to all persons who liave been rejected for military duty on 
account of conditions that are curable and request them to direct such 
persons to apply to you in order that you may assist them as far as 
possible and enable them to enlist and serve their country in a mili- 
tary capacity. You are also requested to inform the chairmen of 
these boards that men who have been rejected for the Army and Navy 
may be admitted to the marine hospitals as service patients if they 
are suffering from remediable infections or other diseases affecting 
the public health, but such persons must not exceed 10 in number in 
any one hospital at one time. 

Respectfully, 

Rupert Blue, 
Surgeon General, 
Approved : 

W. G. McAdoo, Secretary. 



Reports of Clinical Results Observed in Using Arsphenamine. 

Treasury Department, 
Bureau oe the Public Health Service, 

Washington, January 10, 1918. 

Bureau Circular Letter No. 121. 

To commissioned medical offi.cers and acting assistant surgeons United 

States Public Health Service: 

The Director of the Hygienic Laboratory has been directed to send 
to the Purveying Depot ampules of arsphenamine from which sam- 
ples have been tested by the laboratory and found to conform with 
the rules and standards prescribed by this service and promulgated 
by the Federal Trade Commission, November 22, 1917, given in the 
Public Health Reports of December 7, 1917, The medical purveyor 
has been directed to distribute these ampules to the stations for the 
treatment of patients of the service. The directions given in each 
package should be carefully followed. A report on the inclosed 
blanks should be sent to the Director of the Hygienic Laboratory, 
Twenty-fifth and E Streets NW., Washington, D. C, at the end of 
each month, giving the name of the manufacturer, the lot number, 
the dose administered, the method of administration, and the clinical 
results observed in using this preparation, making special reference 
to any untoward reaction. 

Rupert Blue, 
Surgeon General, 
14330°— 21 7 



98 

Addresses of Officers on Field Duty. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, January 16, 1918. 

Bureau Circular Letter No. 122. 

Medical officers, United States Public Health Service, and others con-' 
cerned : 

In order to keep the bureau informed and to avoid possible delays 
in the delivery of mail, all letters sent to the bureau by officers in the 
field should give (below the name of the post office) the street or 
other address of the officer while on that particular detail. 

Whenever practicable, all officers on field duty should also keep the 
bureau informed in advance of changes of address. 

Rupert Blue, Surgeon General. 



' Treasury Department, 

Bureau of the Public Health Service, 

Washington, January 28, 1918. 

Bureau Circular Letter No. 123. 

Commissioned officers, acting assistant surgeons, and others con- 
cerned: 

Your attention is invited to paragraphs Nos. 132, 133, and 134 of 
the regulations of the service directing officers to inform themselves 
fully as to the local health laws and regulations and to comply there- 
with, unless in conflict with national health laws and regulations. 

A number of cities and States have recently issued regulations re- 
garding reporting, examination, period of treatment, and quaran- 
time measures necessary to prevent the spread of venereal diseases. 
You are directed to study carefully these regulations in force in your 
district and to comply with them. In case difficulties arise in carry- 
ing out this order you should communicate with the bureau for 
instructions. 

Rupert Blue, Surgeon General. 



Distribution of Typhoid and Paratyphoid Vaccines. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, March Jf, 1918. 

Bureau Circular Letter No. 124. 

Medical officers. United States Public Health Service, and others 

concerned : 

Bacterial vaccines for prophylactic use are available for distribu- 
tion by the Hygienic Laboratory as follows : 



99 

1. Typhoid vaccine (1,000,000,000 B. typhosus per c. c.) in 1 c. c, 
10 c. c, and 50 c. c. containers. 

2. Mixed paratyphoid vaccine (750,000,000 B. paratyphosus A and 
760,000,000 B. paratyphosus B per c. c.) in 1 c. c. containers. 

3. Triple typhoid-paratyphoid vaccine (1,000,000,000 B. typhosus^ 
750,000,000 B. paratyphosus A and and 750,000,000,000 B. para- 
typhosus B per c. c.) in 1 c. c, 25 c. c, and 50 c. c. containers. 

Requisitions for the above vaccines should be addressed directly 
to the Director, Hygienic Laboratory, Twenty-fifth and E Streets 
NW., Washington, D. C. These requisitions should state explicitly 
{a) the kind and amount of vaccine desired and (6) the sizes of con- 
tainers in which it should be furnished. 

In order to promote economy in preparation and administration, 
officers should order the vaccines in the largest containers practicable 
whenever large numbers of persons are to be vaccinated. The 
vaccines will cost about one-sixth as much if 10 c. c. or 50 c. c. con- 
tainers are used, and even less in 25 c. c. or 50 c. c. containers. Fur- 
thermore, a saving of time will also be effected in administering. 

EuPERT Blue, Surgeon General. 



Cooperation of Service in Child Welfare Activities. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, April 19, 1918. 

Bureau Circular Letter No. 125. 

To coniTTiissioned medical officers, acting assistant surgeons, and 
others concerned: 

In accordance with a request received from the Child Welfare 
Committee of the General Medical Board of the Council of National 
Defense, I desire to request all officers of the service to render their 
cooperation in carrying out the child-welfare program approved by 
the above-mentioned committee. This program corresponds closely 
with previous suggestions of the service, and outlines the following 
essential factors in the protection of mothers and infants in war time : 

Birth registration. 

Prenatal care of mothers. 

Obstetrical care of all women at confinement. 

Infant care under physicians, and especially trained public-health 
nurses. 

A safe and sufficient milk supply. 

Care of the child during the preschool age, especially as regards 
nutrition. 

KuPERT Blue, Surgeon General. 



100 

Care and Treatment of Patients on Account of the Bureau of War Risk 

Insurance. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, April 22, 1918. 

Bureau Circular Letter No. 126. 

To concmissioned medical o'/Jicers, acting assistant surgeons, and 

others concerned: 

In accordance with a decision rendered by the Comptroller of the 
Treasury, and as requested by the Director of the Bureau of War 
Risk Insurance, you are informed that, hereafter, persons who are 
entitled to medical relief under the provisions of act of Congress 
approved October 6, 1917, shall be furnished necessary hospital and 
out-patient treatment at first, second, and third class relief stations 
of the service, upon requests issued by the proper officials of said 
bureau, reimbursement for the care and treatment of such persons to 
be made by a transfer of funds from appropriations for the Bureau 
of War Risk Insurance, at rates charged for the care and treatment 
of officers and enlisted men of the United States Army and Navy, as 
stated in annual circulars entitled " Contracts for the care of sea- 
men, etc." 

Unless specifically authorized in each case, the above-mentioned 
patients are not subject to transfer from contract relief stations for 
the purpose of receiving further treatment. Bills for reimbursement 
on account of treatment furnished said patients should be rendered 
on Forms 1928 and 1929, as the case may be, and monthly reports of 
such treatment should be rendered on Form 1927. 

In vouchers rendered for" the care and treatment of said patients at 
second and third class relief stations, the letters " W. R. I." should be 
given after the name of each patient. 

Rupert Blue, 
Surgeon General. 



Treasury Department, 
Bureau or the Public Health Service, 

Washington, May 14, 1918. 

Bureau Circular Letter No. 127. 

To commissioned medical oncers, acting assistant surgeons, and 

others conce7'ned: 

You are hereby notified that it will be unnecessary hereafter to 
send copies of clinical histories of injured civil employees treated 
at your station to the Employees' Compensation Commission, 



101 

through the bureau, or by the chairman of the Employees' Compen- 
sation Commission. Besides the usual clinical histories of hospital 
patients, a memorandum should be kept on small cards, or otherwise, 
of the diagnosis, symptoms, and treatment of injured civil employees 
treated as out-patients, in case the chairman of the Employees' Com- 
pensation Commission should at any time desire information about 
one of these patients. Special care should be taken in preparing 
forms C. A.-4, C. A.-5, and C. A.-8 of the United States Employees' 
Compensation Commission, as the manner and completeness in which 
these medical blanks are filled out is of great importance to the com- 
mission in determining the merits of the claims. 
EespectfuUy, 

EuPERT Blue, 
burgeon General, 

Malaria Poster. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, May 16, 1918. 

Bureau Circular Letter Ne. 128. 

The Postmaster. 

Sir: I take pleasure in sending herewith a poster describing the 
means of transmission and prevention of malaria. It is of the 
greatest importance that the people generally understand that this 
disease, so serious and prevalent in certain sections, is transmitted 
only by one kind of mosquito and that there are practical and com- 
paratively easy means of preventing it. May I request that you 
cooperate with the United States Public Health Service in its efforts 
to make such knowledge general by placing this poster in some 
permanent, conspicuous place and by seeing that it is not torn down 
or defaced? Permission for placing this poster in your office has 
been granted by the Postmaster General. 

If the poster is destroyed, another copy will be gladly sent on 
request, and copies will also be sent to be posted in other public 
places. 

Thanking you for your cooperation in this attempt to reduce the 
prevalence of malaria, I am, 
EespectfuUy, 

EuPERT Blue, 

Burgeon General, 



102 

Safeguards to be Observed in Performing Fumigation With Hydrocyanic 

Acid Gas. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, June 5, 191S, 

Bureau Circular Letter No. 129. 

To officers of the United States Public Health Service: 

The attention of officers is especially directed to the provisions of 
bureau circular letter No. 100, dated November 4, 1916. The instruc- 
tions contained therein are mandatory and not discretionary, and 
if impracticable of application vessels shall be fumigated with sul- 
phur and not with cyanide gas. 

Vessels that have been fumigated with cyanide shall not be de- 
clared safe subsequent to opening of the hatches and ventilations 
until the holds and compartments have been entered in all parts by 
the quarantine officer or a trusted employee. 

The master of the vessel shall be served with a written notice 
warning against entry of any of the crew to fumigated compart- 
ments until after decision of the quarantine officer as to safety ; and 
the decision as to safety for entering compartments shall also be 
delivered in writing. 

Officers are directed to acknowledge the receipt of this circular. 

Rupert Blue, 

Surgeon General, 



Treasury Department, 
Bureau of the Public Health Service, 

Washington, May 27, 1918. 

Bureau Circular Letter No. 130. 

To commissioned medical officers, acting assistant surgeons, and 

others concerned: 

You are advised that seamen and other beneficiaries suffering from 
venereal diseases should not be discharged from marine hospitals 
until the infectious period has, passed, provided sufficient beds are 
available for their treatment. All patients before their discharge 
from hospitals, or out-patient offices, should be instructed in the 
methods of preventing the spread of venereal diseases and the pre- 
cautions that should be taken not to have sexual intercourse until 
they have been pronounced thoroughly cured by an officer of this 
service or by a reputable physician. 

Rupert Blue, 

Surgeon General, 



103 

Directing Officers to Have All Statements of Accounts Signed by Naval or 
Other Pay Patients; Also Relative to Discontinuing Coast Guard Clinical 
Histories. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ June 11, 1918. 

Bureau Circular Letter No. 131. 

To commissioned medical officers, acting assistant surgeons, and 

others concerned: 

The Auditor for the Navy Department has requested this bureau 
to instruct its officers to secure the signatures, in all cases, of Navy 
patients furnished treatment, before bills are presented for repay- 
ment by the Navy Department. The Surgeon General of the Navy 
states that it is important, in view of this request of the auditor, that 
these signatures should be obtained, as reimbursement will probably 
be impracticable should the auditor insist upon such signatures 
before allowing reimbursement for the care of naval patients. You 
are therefore directed to be careful to have all statements of account 
signed by naval or other pay patients. 

You are advised that copies of clinical histories of Coast Guard 
patients need not in the future be forwarded to the Bureau except as 
follows : 

(1) Upon the request of the Captain Commandant, U. S. Coast 
Guard or the bureau, 

(2) When a patient is recommended for retirement, 

(3) When it is believed a patient can no longer be benefited by a 
stay in the hospital; in such case a recommendation as to his final 
disposition should be made. 

Eespectfully, 

Rupert Blue, 

Surgeo7i General. 



Fire Hose to be Tested Before Ordering New Supplies. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, June 2Jf, 1918. 

Bureau Circular Letter No. 132. 

I'o medical officers in charge, United States marine hospitals and 

quarantine stations: 

1. Numerous requests for authority to secure proposals for fire 
hose to replace the present supplies reported to be unserviceable indi- 
cate an unusually short life for fire hose. 



104 

2. As this material is supplied from funds under the control of the 
Supervising Architect medical officers in charge of marine hospitals 
and quarantine stations will in the future report all fire hose which 
is apparently unserviceable to the bureau, and request a test and in- 
spection by a properly qualified representative of the Supervising 
Architect's Office before making requisition for additional fire hose. 

3. Sections of fire hose showing failure under regulation fire drills 
or other tests shall be removed from service and stored for inspection 
as above indicated, and the fact immediately reported. 

4. All fire hose hereafter placed on the unserviceable property list 
shall, before being condemned by an inspector appointed under 
bureau regulations, be submitted to inspections and tests by a mechan- 
ical inspector of the Supervising Architect's Office and a tag bear- 
ing the inscription, " Inspected and condemned," with the date, name, 
and title of the inspector marked thereon. 

Rupert Blue, 

Surgeon General, 



Malaria Poster. 



Treasury Department, 
Bureau of the Public Health Service, 

Washington^ June 25, 1918. 

Bureau Circular Letter No. 133. 

The Railroad Agent. 

Sir: I take pleasure in sending herewith a poster describing the 
means of transmission and prevention of malaria. It is of the great- 
est importance that the people generally understand that this disease, 
so serious and prevalent in certain sections, is transmitted only by 
one kind of mosquito, and that there are practical and compara- 
tively easy means of preventing it. May I request that you cooper- 
ate with the United States Public Health Service in its efforts to make 
such knowledge general by placing this poster in some permanent, 
conspicuous place and by seeing that it is not torn down or defaced ? 
Permission for placing this poster in your office has been granted by 
Director General of Railroads. 

If the poster is destroyed another copy will be gladly sent on re- 
quest, and copies will also be sent to be posted in other public places. 

Thanking you for your cooperation in this attempt to reduce the 
prevalence of malaria, I am, 
Respectfully, 

Rupert Blue, 

Surgeon Gener'al, 



105 

Additional Compensation at the Rate of $1,200 Per Annum. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ July 19, 1918. 

Bureau Circular Letter No. 134. 

Medical officer in charge and others concerned: 

Section 6 of the legislative, executive, and judicial act, approved 
July 3, 1918, provides that during the fiscal year 1919 all civilian 
employees of the United States Government, receiving an annual 
compensation not in excess of $2,500, shall receive additional com- 
pensation at rate of $1,200 per annum. 

Provided, first. That employees receiving an annual compensation 
at a rate greater than $2,500 shall receive additional compensation at 
such a rate as to make the total compensation not more than $2,620. 

Second. That employees receiving less than $400 per annum shall 
receive an increase at the rate of 30 per cent of the monthly compen- 
sation. 

Third. That where an employee has received during the fiscal year 
1918 or shall receive during the fiscal year 1919 an increase of salary 
in excess of $200 per annum or where an employee has entered in 
service since July 30, 1917, no increase shall be paid until a certifi- 
cate has been made as to the ability and qualifications of such em- 
ployee such as would justify such increased compensation. This cer- 
tificate will be made by the medical officer in charge subject to the 
approval of the head of the department. 

Fourth. Employees whose services are utilized for brief periods 
or whose employment is of an intermittent nature, such as laborers 
employed in extra-cantonment zones, will not be entitled to the in- 
crease of compensation. 

Fifth. Persons whose duties require only a portion of their time, 
but who hold themselves in readiness to work whenever called on, 
will be entitled to the increase. 

This circular supersedes bureau circular letter No. 116, dated July 
6, 1917, as to rate of increase. 

Pay roll forms Nos. 1948, 1952b, and 1952c will be used in the same 
manner as during the fiscal year 1918. 

KuPERT Blue, 

Surgeon General. 



106 

Relative to Regulations Concerning Federal Compensation Act. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ July £5, 1918. 

Bnreaa Circular Letter No. 135. 

7^6> commissioned medical officers., acting assistant surgeons., and 

others concerned: 

There is transmitted herewith a copy of the Regulations Concern- 
ing Duties of Employees, Official Superiors, Medical Officers, and 
Others under the Federal Compensation Act of September 7, 1916, 
together with a list of physicians and hospitals available for the 
treatment of civil employees of the United States who are injured 
while in the performance of their duty. 

Officers of this service are directed to thoroughly familiarize them- 
selves with these regulations and to render any assistance within their 
power to persons desiring to make claim under the Federal com- 
pensation act, in order to assist the United States Employees' Com- 
pensation Commission in its task of administering the above act. 
Respectfully, 

Rupert Blue, 

Surgeon General. 



Treasury Department, 
Bureau of the Public Health Service, 

Washington, July 31, 1918. 

Bureau Circular Letter No. 136. 

To State and local health authorities and others concerned : 

Inasmuch as there is no doubt that shaving brushes infected with 
anthrax are to be found in trade channels in the United States, ad- 
ministrative action is required. Regulations have been adopted 
which will prevent the further interstate shipment of infected 
brushes, but in order to protect the public in the use of shaving 
brushes already in trade channels, sterilization is recommended be- 
fore use of all brushes made from material not sterilized in the proc- 
ess of manufacture. These are chiefly brushes made of horsehair 
with or without an outside layer of imitation badger hair. 

For sterilization of brushes, the following procedure is suggested : 
The brush should be soaked for four hours in a 10 per cent solu- 
tion of formalin (by formalin is meant a 40 per cent solution of 
formaldehyde). The solution should be kept at a temperature of 
110° F. and the brush so agitated as to bring the solution into contact 
with all hair or bristles. 



107 

I shall be obliged to you for bringing this information to the 
attention of all those interested. 
Eespectfully, 

Rupert Blub, 

Surgeon General. 

Form of Certificate Required to Procure Additional Compensation at the Rate 

of $120 Per Annum. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, August i, 1918. 

Barean Circular Letter No. 137. 

Medical officers in charge, and others concerned: 

The certificate required by section 6 of the act approved July 3, 
1918 (Public, No. 188) , should be in the following form : 

* received on July 1, 1917, a salary of $ 

(Designation and name.) 

he is now receiving a salary of $ 

' was appointed at a salary of $ and now 

(Designation and name.) 

receives a salary of $ . 

*The services performed by him and his ability and 

(State character of services.) 
qualifications are entirely satisfactory. 
Respectfully, 



Appi*oved and respectfully forwardea to the Secretary of the Treasury with 

the recommendation that be certified entitled to in- 

( Designation and name.) 
creased compensation. 



/Surgeon General. 
New employees and those selected to fill vacancies occurring should be recom- 
mended for appointment at the base rate of pay as no certificate can be made 
relative to their ability and qualifications until after a period of service has 
elapsed ; it is thought that one month will be a fair probationary period after 
which the certificates in the above-prescribed form may be transmitted to the 
bureau if the conduct and capacity of the probationer warrants it. 
Respectfully, 



Surgeon General. 

Rupert Blue, 

Surgeon General. 



1 Use this form for employees in the service June 30, 1917. 
" Use this form for employees who have entered the service since June 30 1917. 
»This statement as to character of services, ability, and qualifications applies to both 
classes. 



108 

Army, Navy, and War Risk Patients to be Placed on Separate Vouchers. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ August 13, 1918. 

Bnrean Circular Letter No. 138. 

To commissioned medical oficers, acting assistant surgeons, and others 

concerned : 

You are advised that arrangements have been made with the War 
and Navy Departments and with the War Risk Insurance Bureau 
of the Treasury Department to pay for the care and treatment of 
their patients under the charge of this service at second, third, and 
fourth class relief stations, by direct payment to the payee by dis- 
bursing officers' checks upon receipt of vouchers signed by the payee 
and certified by the medical officer in charge of the station. Youi 
are therefore directed hereafter to forward separate vouchers for' 
each of the above class of patients, as follows : 

army patients. 

Vouchers for Army patients should be prepared on War Depart- 
ment Form No. 356, a supply of which is inclosed. The first cer- 
tificate should be signed by the payee; the second should be com- 
pleted by filling in the names of the Army officers who requested the 
treatment or services and certified by the medical officer in charge 
of the station. Each voucher must be accompanied by the original 
requests for treatment. Only one request is necessary, regardless 
of the length of time a patient remains under treatment. Vouchers 
should be rendered promptly at the end of each month. 

NAVY PATIENTS. 
[Includes U. S. Naval Reserve Force but not members of U. S. Coast Guard.] 

Vouchers for Navy patients should be prepared on Public Health 
Service Forms Nos. 1926 and 1949, and should be headed "United 
States Navy" just above the line for "Appropriation." They should 
be signed by the payee and certified by the medical officer in charge 
of the station, and must be accompanied by the original requests 
for treatment. Only one request is necessary, regardless of the 
length of time a patient remains under treatment. Vouchers should 
be rendered promptly at the end of each month. Stubs of these 
vouchers should be completely filled in at the station. 

war-risk insurance PATIENTS. 

Vouchers for war-risk patients should be prepared on Public Health 
Service Forms Nos. 1926 and 1949 and headed "Bureau of War Risk 
Insurance " just above the line for "Appropriation." They should be 



109 

signed by the payee and certified by the medical officer in charge of 
station and must be accompanied by the original, regardless of the 
length of time a patient remains under treatment. Vouchers should 
be rendered promptly at the end of each month. Stubs of these 
vouchers should be completely filled in at the station. 

All vouchers for the above-named three classes of patients should 
include not only charges for hospital care and treatment but miscel- 
laneous services under contract, such as ambulance and X-ray service, 
use of operating room, etc. 

The three classes of patients mentioned above should not hereafter 
be included in the monthly report of relief furnished foreign seamen, 
Form No. 1927, at second, third, and fourth class stations unless out- 
patient relief has been furnished. 

The rendering of repayment accounts. Form No. 1928, covering 
treatment and services for the above-named three classes of patients 
in hospital, should hereafter be discontinued at second, third, and 
fourth class stations. When out-patient relief is furnished, repay- 
ment accounts, Form No. 1929, should be rendered in duplicate. 

All vouchers rendered for direct payment by the War Department, 
Navy Department, and Bureau of War Risk Insurance should not be 
listed on monthly schedule of encumbrances. Form No. 1955. 

All portions of Bureau Circular Letter No. 131, dated June 11, 1918, 
and unnumbered bureau circulars dated April 14, 1917, and April 10, 
1918, in conflict with the above, are hereby annulled. 

Rupert Blue, 
Surgeon General. 



Military Status of Commissioned Medical Officers. 

Treasury Department, 

BuREAtr OF THE PuBLIC HeALTH SeRVICE, 

Washington^ August 13^ 1918. 

Bareaa Circular Letter No. 139. 

For the information of commissioned medical officers: 

The following quotation is made from a letter of the honorable 
the Secretary of War to the honorable the Secretary of the Treasury : 

As the commissioned officers of the Public Health Service are engaged on 
important public health and sanitation work, especially in the vicinity of Army 
and Navy training camps, as they are in charge of the hospitals of the Public 
Health Service to which officers and enlisted men of the Navy may be admitted 
tinder certain conditions, and as that service is experiencing difficulty in main- 
taining its commissioned personnel, the Provost Marshal General has recom- 
mended that a broader interpretation be given to the Executive order of April 
3, and that the Selective Service Regulations (note 3, sec. 79) be amended in 
this respect so as to include all officers of the Public Health Service commis- 
sioned under authority of the act of January 4, 1889. The regulations have 
been amended accordingly. 



110 

The office of the Provost Marshal General has amended section 79, 
note 3, of the Selective Service Regulations and has communicated 
the same to draft executives in all States, as follows : 

The words, " Persons in the military and naval service of the United States," 
as employed in said act of Congress and in these regulations, shall be con- 
strued as including all officers and enlisted men of the Regular Army, the Regu- 
lar Army Reserve, the Officers' Reserve Corps, and the Enlisted Reserve Corps ; 
all officers and enlisted men of the Navy, the Marine Corps, and the Coast 
Guard ; all officers and enlisted men of the Naval Volunteers recognized by the 
Navy Department ; all officers of the Public Health Service commissioned under 
authority of the act of January 4, 1889; and any of the personnel of the Light- 
house Service and of the Coast and Geodotic Survey transferred by the Presi- 
dent to the service and jurisdiction of the War Department or of the Navy 
Department. 

Rupert Blue, /Surgeon General. 



Treasury Department, 
Bureau of the Public Health Service, 

Washington, Septeniber 5, 1918. 

Bureau Circular Letter No. 140. 

For the information of commissioned medical officers: 

Owing to some uncertainty as to whether commissioned officers 
falling within the age limits of the new draft should register, al- 
though a recent ruling of the Provost Maic>liai General has placed 
them definitely as a part of the military forces, it seems advisable, 
as specific mention is not made of the Public Health Service in the 
President's proclamation, that officers register. 

Upon registration, they will not be subject to call and will be 
placed in class 5, Section D, as a part of the military forces in accord- 
ance with Executive order of April 3 and Selective Service Regu- 
lations of the Provost Marshal General. , 
Respectfully, 

Rupert Blue, Surgeon General. 



Information in Regard to Commutation for Heat and Light. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, September 16, 1918. 

Bureau Circular Letter No. 141. 

To commissioned officers, United States Public Health Service: 

For the information of the commissioned medical officers, it may 
be stated that officers drawing commutation will not be allowed heat 
and light allowances unless quarters are occupied at the station from 



Ill 

which they receive commutation; for instance, a person drawing 
commutation as a result of his station at New York and occupying 
rooms at Cohimbia, S. C, will not be allowed heat and light allow- 
ances for the rooms he occupies at the latter station. 
Respectfully, 

Rupert Blue, 

Surgeon General. 



" Spanish " Influenza Poster. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, September 26, 1918. 

Bnr«aa Circular Letter No. 142. 

The Postmaster. 

Sir: I take pleasure in sending herewith a poster describing the 
means of transmission and prevention of " Spanish " influenza. It 
is of the greatest importance that the people generally understand 
that this disease, so serious and prevalent at this time, is a crowd 
disease, probably spread mainly by coughing, sneezing, and spitting 
in public places and by the use of common drinking cups, common 
towels, etc. May I request that you cooperate with the United 
States Public Health Service in its efforts to make such knowledge 
general by placing this poster in some permanent, conspicuous place 
and by seeing that it is not torn down or defaced ? Permission for 
placing this poster in your office has been granted by the Postmaster 
General. 

If the poster is destroyed, another copy will be glady sent on 
request, and copies will also be sent to be posted in other public 
places. 

Thanking you for your cooperation in this attempt to prevent the 
spread of this disease, I am. 
Respectfully, 

Rupert Blue, 

Surgeon General. 



" Spanish " Influenza Poster. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, Seftemher 26, 1918. 

Burean Circular Letter No. 143. 

The Railroad Agent. 

Sir: I take pleasure in sending herewith a poster describing the 
means of transmission and prevention of " Spanish " influenza. It 



112 

is of the greatest importance that the people generally understand 
that this disease, so serious and prevalent at this time, is a crowd 
disease, probably spread mainly by coughing, sneezing, and spitting 
in public places and by the use of common drinking cups, common 
towels, etc. May I request that you cooperate with the United States 
Public Health Service in its efforts to make such knowledge general 
by placing this poster in some permanent, conspicuous place, and 
by seeing that it is not torn down or defaced? Permission for 
placing this poster m your office has been granted by the Director 
General of Eailroads. 

If the poster is destroyed another copy will be gladly sent on re- 
quest, and copies will also be sent to be posted in other public places. 

Thanking you for your cooperation in this attempt to prevent the 
spread of this disease, I am 

Respectfully, Rupert Blue, 

Surgeon General. 

Information Relative to Claiming Deferred Classfiication. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, Septetriber 28, 1918. 

Bureau Circular Letter No. 144. 

To commissioned officers and the noncommissioned scientific per' 

sonnel : 

Under the provisions of Department Circular No. 122, it is desired 
that deferred classification should be requested in the case of em- 
ployees whose services are absolutely necessary to the successful 
prosecution of work and whose places can not be satisfactorily filled. 
As bearing on the questionnaire, the following interpretations are 
presented for individual guidance : 

1. Commissioned officers are exempted under class 5 A, as defined 
in part 13, Treasury Department, and notation on the questionnaire 
should be made accordingly. 

2. The classification of commissioned officers is 5 A. The classifi- 
cation of the noncommissioned personnel is 3 I. 

3. Under subheading of occupation, series 1, general questions, 
medical officers should classify themselves as physicians, 43 P, under 
key list of occupations. 

Under heading of special work, should state commissioned officers, 
U. S. P. H. S. 

Noncommissioned personnel should designate character of work 
being performed and state under special work, U. S. P. H. S. 



113 

4. Under the series enumerated below, the answers should be given 
as indicated: 



Series 3. 



Series 6. 



Series 8A. 



Series 11. 



Commissioned officers 

Noncommissioned personnel. 



Yes. 
No.. 



Yesi. 
No... 



No. 
No. 



No. 

Yes. 



' Add section 79, note 3, amendment Provost Marshal General, Aug. 5, 1918. 

5. The bureau will claim deferred classification of such -individuals 
in the noncommissioned scientific personnel as may be recommended 
by the officer in charge of the work that their services are indispens- 
able and the position they occupy can not be filled. 

6. A memorandum setting forth in considerable detail the reasons 
why deferred classification is asked, with special reference as to why 
the registrants' services can not be replaced by another without 
material loss to the Government, should be made and transmitted 
with application for deferred classification. 

Eespectfully, 

Rupert Blue, 

Burgeon General. 

Relative to Treatment of Venereal Diseases. 

Treasury Department, 
Bureau of the Public Health Service, 

'Washington^ November 13^ 1918. 

Barean Circnlar Letter No. 145. 

To ^omTnissioned medical officers^ acting assisting surgeons and 

others concerned: 

You are informed that the bureau desires that the treatment of 
venereal infections in marine hospitals and relief stations shall fully 
conform to the highest modern standards, in so far as this concerns 
the work at your station, you are directed to give it your immediate 
and particular attention. A copy of the Manual of Treatment of 
the Venereal Diseases, issued from the office of the Surgeon General 
of the Army and enlarged by the bureau, will be mailed to you soon. 
You will take immediate steps to ascertain what additional instru- 
ments, supplies, drugs, and assistance you need in order to carry 
out modern methods of treatment and make prompt requisition for 
the same. 

The instructions contained in Bureau Circular Letters No. 123, 
dated January 28, 1918, and No. 130, dated May 27, 1918, relative to 
complying with local health regulations regarding the reporting, 
examination, period of treatment, and quarantine measures neces- 
sary to prevent the spread of venereal diseases should be carefully 
14330°— 21- 8 



114 

followed. In addition you are directed to have each patient in- 
structed as to the nature of his disease and how to avoid conveying 
it to others, and to hand him a copy of the circular of information 
on venereal diseases, copies of which are inclosed with this letter. 
A further supply of these circulars can be obtained from the bu- 
reau upon request. 
Respectfully, 

Rupert Blue, 

Surgeon General. 

Instructions Concerning Use of Government Transportation Requests. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ Noveniber 23^ 1918. 

Bureau Circular Letter No. 146. 

To commissioned medical officers, acting assistant surgeons, and 

others concerned: 

It has been decided that, effective December 1 next, the additional 
charge for passage in sleeping and parlor cars will be represented by 
the sleeping or parlor car ticket issued for the space occupied. 

This will necessitate some change in the present method of issuing 
transportation requests in the following particulars : 

1. Request for railroad tickets must be drawn on the railroad com- 
pany as heretofore, but must not include the additional passage 
charge. Such requests will be honored only for tickets at coach 
fares. 

2. Requests for sleeping or parlor car accommodations will be 
assumed to include the additional passage charge for travel in sleep- 
ing or parlor cars unless the request is specifically indorsed to the 
contrary. 

3. In cases where it is desired to pay additional passage charge 
beyond the point to which the request for sleeping or parlor car 
accommodations reads, "A separate request should be drawn on the 
sleeping or parlor car company for the additional passage charge 
from starting point to the desired' destination," and the request for 
sleeping or parlor car space should be indorsed specifically that it 
does not include the additional passage charge. 

All collections for additional passage charges for travel in sleep- 
ing or parlor cars, " whether included in the request for sleeping or 
parlor car accommodations or in a separate request," will be made by 
the sleeping or parlor car company and not by the railroad company. 
Detailed information concerning the new arrangement may be ob- 
tained from agents and conductors. 

Rupert Blde, 
Surgeon General. 



115 

Treasury Department, 

BUREATJ OF THE PtJBLIC HeALTH SeRVICE, 

Washington^ January 3, 1919. 

Bnreaa Circular Letter No. 147. 

Oncers of the United States Public Health Service^ assigned to extra- 
cantonment zones and to State hoards of health: 
In writing to the Division of Venereal Diseases regarding current 
activities, you are instructed to write separate letters regarding 
medical and educational measures, and in general to write separate 
letters regarding distinctly different matters instead of including 
them in a single letter. 
Respectfully, 

Etjpert Blue, 
Surgeon General. 



Reports of Relief for the United States Employees' Compensation 

Commission. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington^ Deceniber 27, 1918. 

Bnrean Circular Letter No. 148. 

To commissioned officers., acting assistant surgeons, and others con- 
cerned: 

The following blanks for recording and reporting injuries to civil 
employees of the Government will be forwarded to you in a few 
days by the United States Employees' Compensation Commission : 

1. Medical record of injury and treatment {Form GA-19) . — This 
form should be filled out in all cases where an injured civil employee 
applies for treatment. If the medical officer feels confident that an 
employee is not entitled to the benefits of the compensation act, his 
reasons for so thinking should be noted under " Remarks." Sup- 
plementary case records giving a more detailed clinical history of 
the case should be kept in all instances of serious injury. 

2. Medical report of injury to United States employee {Form , 
CA-20). — This report should be forwarded to the United States 
Employees' Compensation Commission as soon as the required infor- 
mation regarding the case, including the nature and extent of injury, 
shall have been ascertained. 

3. Discharge report of injury case {Form CA-21). — This report 
should be forwarded to the United States Employees' Compensation 
Commission when an injured civil employee is discharged from 
treatment. 



116 

The forwarding of these reports, Forms CA-20 and CA-21, should 
be begun January 1, 1919, and should include those cases previously- 
treated, but which are still under treatment on January 1. 

Requests for additional blanks should be sent direct to the office 
of the Compensation Commission. 
Eespectfully, 

J. C. Perry, 
Acting Surgeon General. 



Examination of Disabled Men for the Federal Board for Vocational 

Education. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, December 30, 1918. 

Bnrean Circular Letter No. 149. 

To commissioned O'fflcers, acting assistant surgeons, and others con- 
cerned: 

You are advised that upon request made by the district vocational 
officer of the Federal Board for Vocational Education an examina- 
tion should be made by you of a disabled man discharged from the 
military forces desiring to enter upon a course of vocational train- 
ing, placing him for a few days, if necessary, in the marine hospital 
or contract hospital for observation or special examination to de- 
termine the feasibility of his entering upon such a course. Such 
discharged soldier or sailor must be under compensation as a condi- 
tion precedent to training, as provided by law. 

If the patient has been in a contract hospital, a bill should be 
made out on Form No. 1926 for transmission through the bureau to 
the Federal Board for Vocational Education for payment at the con- 
tract rate for the number of days he has been at the hospital. 

If the man has been in a marine hospital repayment account should 
be rendered on Form No. 1928 at the same rate as is charged in T. D. 
37671 for war risk patients, and the names of such persons reported 
on monthly report of relief furnished foreign seamen or other pay 
patients, Form No. 1927. 

All papers concerning the above, including vouchers, relief certifi- 
cates, and hospital permits, should be headed "Federal Board for 
Vocational Education." 
Kespectfully, 

Rupert Blue, 

Surgeon General, 



117 

Treatment of Beneficiaries of the War Risk Insurance Bureau. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, January 3, 1919. 

Bureau Circular Letter No. 150. 

To cominissioned medical officers, acting assistant surgeons, am.d 

others concerned: 

Applicants for compensation under the provision of the war-risk 
insurance act are entitled to examination and treatment by officers of 
the service. 

Some complaints have been received that they have not always re- 
ceived proper consideration. 

When an applicant for compensation presents proper credentials 
from the War Risk Bureau, he should be treated courteously and the 
examination made without undue delay. 

The officer in charge of a station where such examinations are 
made will be expected to notify the bureau promptly if his personnel 
is not adequate for the proper conduct of this work. 
Respectfully, 

Rupert Blue, 
Surgeon General. 



Information for Applicants for Appointment and Commission in the Reserve 
of the United States Public Health Service. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, January 11, 1919. 

Bureau Circular Letter No. 151. 

The Reserve of the Public Health Service is organized for the 
purpose of making available a corps of physicians, sanitarians, and 
scientists who may in time of national emergency be called to active 
duty in the Public Health Service. 

The reserve officers will ordinarily remain on inactive duty but 
subject to call at any time. When an emergency arises, they may be 
called to active service; and while so serving they will receive the 
compensation of their grade. The duties which reserve officers will 
be expected to perform are similar to those of regular officers of the 
Public Health Service. 

In the event that you wish to be considered for membership in the 
Reserve, it is requested that you comply with paragraph 4 of the 



118 

Rules and Eegulations for the Government of the Reserve of the 
United States Public Health Service, which provides as follows: 

Citizens of the United States desirous of undergoing examination for appoint- 
ment and commission in the Reserve of the Public Health Service must make 
an application in their ovt^n handwriting requesting permission to appear before 
a board of examiners. An applicant for examination shall state his age, date 
and place of birth, present legal residence, whether he is a citizen of the 
United States ; give the names of the schools or colleges of which he is a 
graduate ; furnish testimonials from at least two persons as to his professional 
and moral character ; and submit a recent photograph of himself. An appli- 
cant of foreign birth must furnish proof of American citizenship. 

Respectfully, 

Rupert Blue, 

Surgeon General. 

Tkeasubt Department, 
Bureau of the Public Health Service, 

Washington^ January 12, 1919. 

Bnrean Circular Letter N«. 152. 

To commissioned officers and officers in charge of field worh : 

In organizing the Reserve of the Public Health Service it is de- 
sired to consider for appointment and commission on the inactive list 
STich persons of medical, sanitary, and scientific attainments as officers 
of the service wish to recommend. Men who have had experience in 
service work, and whose qualifications have proven satisfactory will 
be especially useful as members of the reserve. It is not expected , 
however, that they will be assigned to active duty except in time of 
emergency. Officers are also requested to furnish the names of per- 
sons whom they believe qualified to render efficient services, even 
though such persons have never held positions in the service. 

In recommending candidates for the reserve, officers are cautioned 
to include only such persons as they conscientiously believe are quali- 
fied to become officers. 

Upon receipt of recommendations from officers, the persons recom- 
mended will be provided with instructions as to the method of pro- 
cedure to be followed in applying for appointments and commissions 
in the reserve. 

Respectfully, 

Rupert Blue, 
Surgeon General, 



119 

Report of Clinical Results Observed in Using Arsphenamine and 
N eoarsphenamine. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ January 28, 1919. 

Bureau Circular Letter No. 153. 

I'o commissioned jnedical officers, acting assistant surgeons, United 
States Public Health Service, and others concerned: 
You are instructed to forward to the Director of the Hygienic Lab- 
oratory reports of any fatal or unfavorable results frbm the use of 
arsphenamine and neoarsphenamine. 

In such reports should be included all immediate or delayed re- 
actions or failures of the drugs to give proper therapeutic response 
and any other unfavorable results. These reports should be made 
immediately after the unfavorable results have been observed and 
should include the following information: The manufacturers of 
the drug and the lot number ; the name, age, and sex of the patient ; 
the stage of the disease ; the presence of any complications ; the dose 
of the drug given ; the amount of sodium hydroxide required for neu- 
tralization in the case of arsphenamine; the total dilution, i. e., the 
total amount of fluid injected; and the length of time occupied in 
the administration. 

The monthly report previously required by bureau circular letter 
dated January 10, 1918, No. 121, need no longer be forwarded. 

EuPERT Blue, 
Surgeon General. 



Information Relative to Military Status of the Personnel of the United 
States Public Health Service and Its Bearing on Specific Exemption of 
$2,500 Salary or Compensation Received by Persons in Military and Naval 
Forces of the United States During the Present War. 

Treasury Department, 
Bureau of the Public Health Service, 

W ashington March 1, 1919. 

Bnrean Circular Letter No. 154. 

To commissioned medical officers and other personnel, United States 

Puhlic Health Service: 

The revenue act defines as follows: 

The term '" military or uaval forces of the United States" includes the 
Marine Corps, the Coast Guard, the Army Nurse Corps (female), and the Navy 
Nurse Corps (female) but this shall not be deemed to exclude other units other- 
wise included within such term. 



120 

The Executive order approved by the President April 3, 1917, 
constituted the personnel of the United States Public Health Service 
a part of the military forces of the United States and the Commis- 
sioner of Internal Eevenue, taking into consideration the definition 
of the act as to what constitutes military and naval forces and the 
provisions of the Executive order mentioned, has ruled as follows : 

Inasmuch as the present is within the language of the Executive 
order a time of " actual war " it is clear that the personnel of the 
Public Health Service constitutes a part of the military forces of 
the United States. / 

The definition found in the act expressly declares that it shall not 
be deemed to exclude other units otherwise included within the term 
" military forces of the United States." 

The personnel of the Public Health Service are therefore, " per- 
sons in the military * * * forces of the United States " within 
the meaning of section 213 (b) (8) of the revenue act of 1918. 
Eespectfully, 

Rupert Blue, 

Surgeon General. 

Physical Examinations of Recruits for United States Merchant Marine. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington March 1, 1919. 

Bureau Circular Letter No. 155. 

To commissioned medical officers^ acting assistant surgeoTis, United 
States Public Health Service, and others concerned: 
Capt. William D, Southwick, supervisor of enrolling agents, 
United States Merchant Marine Recruiting Service of the United 
States Shipping Board, has requested that this service examine re- 
cruits who are to be trained on their training ships. You are, there- 
fore, directed upon the written request of an agent of the United 
States Merchant Marine of the United States Shipping Board, to 
make a physical examination upon a blank which the said United 
States Merchant Marine Recruiting Service will furnish of any re- 
cruit applying to your office for this purpose, and send a repoi*t to 
the agent making said request. 
Respectfully, 

Rupert Blue, 

Surgeon General. 



121 

Obituary Notice of Surg. Donald Herbert Currie. 

Treasurt Department, 
Bureau or the Public Health Service, 

Washington, March 8, 1919. 

Bureau Circular Letter No. 156. 

To commissioned oficers and others^ United States Public Health 
Service: 

It is with regret that the bureau has to announce the death of one 
of its trained officers, Surg. D. H. Currie, on December 23, 1918, 
from pneumonia following influenza. 

Surg. Currie rendered excellent service to his Government in 
the several activities of the service. He was an industrious officer, 
and by his gentlemanly bearing made many friends. His effi- 
ciency was shown in the various activities in which he was detailed. 
He was appointed an assistant surgeon January 28, 1889; passed 
assistant surgeon, July 28, 1904; and surgeon, December 1, 1912. 

During his career as an officer he performed duty in nearly all 
the activities of the service at the following stations ; 
San Francisco marine hospital; 
Plague laboratory, San Francisco; 
San Francisco quarantine station ; 

In charge of the research laboratory at the leper colony, Bos- 
ton quarantine station. 

Rupert Blue, 
Surgeon General. 



Obituary Notice of Assistant Surg. Hugh David Ward. 

Treasury Department, 
Bureau or the Public H^ialth Service, 

Washington, March 8, 1919. 

Bureau Circular Letter No. 157. 

To commissioned officers and others, United States Public Health 

Service : 

It is with regret that the bureau has to announce the death of 
Assist. Surg. H. D. Ward, which occurred in Spartanburg, S. C, 
on February 18, 1919, from influenza. Assist. Surg. Ward was one 
of our most brilliant young officers and, although he had been in 
the service only since March 1, 1918, he had demonstrated his 
ability, and the service has suffered a distinct loss by his death. 



122 

Assist. Surg. Ward had been engaged in extra-cantonment san- 
itation and had rendered conspicuous service in this particular. 
He made many friends and accomplished results without friction, 
and gave promise of being one of our most valuable officers. It is 
indeed a sorrow to have one so capable have his career terminated 
by a disease which he was fighting to suppress. 

E.UPERT Blue, 
Surge on General. 



Relative to Requisitions for Supplies. 

Treasury Department, 
Bureau of the Public Healtp: Service, 

Washington, March 11, 1919. 

Bureau Circular Letter No. 158. 

To C omTnissioned Medical Officers, Acting Assistant Burgeons, Phar- 
macists, United States Public Health Service, and others concerned: 
You are informed that the following is a copy of section 3 of the 
act of Congress approved March 3, 1919, to provide care for dis- 
charged soldiers, sailors, marines, and others : 

Sec. 3. The Secretary of War is hereby authorized and directed to transfer, 
without charge, to the Secretary of the Treasury for the use of tlie Public Health 
Service sucli hospital furnitiu-e and equipment, including hospital and medical 
supplies, motor trucks, and other motor-driven vehicles, in good condition, not 
required by the War Department, as may be required by the Public Health 
Service for its hospitals, and the President is authorized to direct the transfer 
to the Treasury Department of the use of such lands or parts of lands, build- 
ings, fixtures, appliances, furnishings, or furniture under the control of any 
other department of the Government not I'equired for the purposes of such 
department and suitable for the uses of the Public Health Service. 

In accordance with the provisions contained in the above-quoted 
section, you are directed to make requisition hereafter in conform- 
ity with the lists of Army supplies, copies of which are inclosed here- 
with. Such requisitions must be made out on requisition blanks 
issued by the War Department, limited supplies of which are for- 
warded to you under separate cover. Six copies of each requisition 
should be prepared on these blanks as follows, viz : Two white, two 
yellow, and two blue. A copy made out on yellow form should be 
retained at your station and the other five copies sent direct to the 
Purveying Depot. Separate requisitions should be made for the fol- 
lowing, viz : Post supplies, field supplies (of which it is not expected 
you will require), dental supplies. X-ray supplies, laboratory sup- 
plies, biological and salvarsan supplies, and special equipment. Req- 
uisitions should be made in anticipation of your needs for approxi- 
mately six months. The sending of special requisitions should be 
avoided as much as possible, although the needs of your station must 
not be neglected in order to avoid making such requisitions. The fol- 



123 

lowing instructions should be observed in filling out requisition 
blanks : 

I. After the words " Requisitioned by " write U. S. Public Health 
Service. 

II. After the words " Ship to " write the usual address for ship- 
ments to be delivered to your station. 

III. After the word " via " state whether by freight or express 
Shipments should not be made by express unless warranted by the 
needs of your station. 

IV. Do not fill in any other blank spaces appearing in heading of 
the requisition blanks. Other spaces will be filled in at the Purvey- 
ing Depot. 

V. In body of requisition, give, first, number of units required, 
second, the unit, and third, the name of the article. The name of 
articles and units should be given as mentioned in the inclosed lists. 

VI. Do not sign requisitions, but forward them with letter of 
transmittal. Requisitions will be signed, dated, and numbered at the 
Purveying Depot. 

Upon the receipt of supplies named on requisitions to be furnished 
by the Army, sign and forward a copy of invoice covering same to the 
Purveying Depot. 

Supplies or equipment not mentioned on the inclosed lists, if con- 
sidered necessary for use at your station, should be taken up on 
requisition blanks issued by the Public Health Service, as heretofore. 

For your information, a copy of the Manual of the Medical De- 
partment of the Army, a list issued by that department as a guide 
for the equipment of a thousand-bed hospital, and lists of staple medi- 
cal and surgical supplies prepared by the Council of National De- 
fense giving a description of many of the articles on the supply table, 
are also forwarded under separate cover. 

You will acknowledge the receipt of this letter. 
Respectfully, 



Rupert Blue, 

Surgeon General. 



Relative to Admission to Service Relief Stations of Beneficiaries of the 
Bureau of War Risk Insurance Provided in Public Act 326. 

Treasury Department, 



Bureau of the Public Health Service 



. Washington^ March £0, 1919. 

Burean Circular Letter No. 159. 

To commissioned medical officers, acting assistant surgeons, United 
States Public Health Service^ and others concerned: 
In accordance with public act 326, approved March 3, 1919, en- 
titled " An act to authorize the Secretary of the Treasury to provide 



124 

hospital and sanatorium facilities for discharged sick and disabled 
soldiers, sailors, and marines," you are directed to admit to any relief 
station of the Public Health Service any discharged sick or dis- 
abled soldier, sailor, or marine. Army or Navy nurse (male and 
female), provided that the disability for which he seeks treatment 
is due to illness or injury incurred previous to discharge from the 
military forces. 

When a reasonable doubt exists whether the disability or injury 
occurred before discharge, the applicant should be placed under 
treatment and a statement of the case submitted direct to the Chief 
Medical Advisor, Bureau of War Risk Insurance, for decision as to 
his eligibility. 

The applicant must present evidence of illness or disability at the 
time of his separation from the service, either by official discharge 
or his hospital record. When this evidence can not be had immedi- 
ately and the seriousness of the applicant's condition does not war- 
rant delay, he may be admitted and his papers secured as early as pos- 
sible. If the applicant has a certificate of discharge without state- 
ment of any disability, the officer in charge may consider whether the 
disability for which he claims treatment is due to a reactivation of a 
condition for which he had previously received treatment while in 
the military service, or if the present disability can be reasonably 
connected with a former injury or disease incurred in the military 
service. 

All persons discharged from the military forces applying for medi- 
cal relief under this act shall, when able, and unless they have pre- 
viously done so, fill out Form No. 526. The medical officer shall fill 
out Form No. 504, both forms being forwarded promptly to the Chief 
Medical Advisor, Bureau of War Risk Insurance. 

Application for a supply of Form No. 526 should be made to the 
Deputy Commissioner of Compensation, Bureau of War Risk In- 
surance. 

Respectfully, 

J. C. Peeby, 
Acting Surgeon General. 

Revision of Service Regulations. , 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ April 7, 1919. 

Bureau Circular Letter No. 160. 

To commissioned oncers and pharmacists, United States Public 

Health Service: 

A board of officers has been detailed for the purpose of revising the 
regulations of the United States Public Health Service. In order 



125 

that all officers may have the opportunity of presenting individual 
suggestions as to desirable changes in the regulations, this circular 
letter is sent out at this time and all officers are requested to forward 
their suggestions to the bureau not later than May 15, 1919. The re- 
vision to be considered by the board will include both the regulations 
approved March 4, 1913, and the Eeserve Eegulations approved 
November 13, 1918. 
Respectfully, 

Rtjpert Blue, 
Surgeon GeTierdl. 

Relative to Purchase of Motor Vehicles' Accessories, Including Oil and 
Gasoline; Also Repair of Motor Vehicles. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ AprU 16, 1919. 

Bareaa Circular Letter No. 161. 

To commissioned m^edical offtcers, acting assistant surgeons, 'pharrrm- 
cists, United States Public Health Service, and others concerned: 
You are advised that the sale by the Army of oils, gasoline, and 
accessories, supplies, and spare parts for motor vehicles of this serv- 
ice, also the repair of motor vehicles belonging to this service, has 
been arranged with the Chief of the Motor Transport Corps and 
the Director of Purchase, Storage and Traffic. The cost thereof will 
be charged to appropriations under the control of this bureau, and 
the Army will be reimbursed by the usual transfer of funds. 

The accessories, supplies, and spare parts for motor vehicles, also 
repairs of motor vehicles, will be furnished by any district Motor 
Transport officer. 

The oils and gasoline will be furnished by the zone supply officer 
at any camp or town where the Quartermaster Department has a 
depot. 

You are requested to purchase the supplies mentioned from the 
agencies named when necessary and have all repairs to motor vehicles 
made by them. 

EespectfuUy, 

Rupert Blue, 

Surgeon General. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, April 21, 1919. 

Borean Circular Letter No. 162. 

To State and local health authorities and others concerned: 

The continued occurrence of cases of anthrax due to infected 
shaving brushes leads this bureau to believe that the suggestion con- 



126 

tained in Bureau Circular Letter No. 136, dated July 31, 1918, recom- 
mending the sterilization of all brushes in trade channels is not being 
complied with. Attention is therefore again called to the fact that 
there are still undoubtedly in trade channels shaving brushes made 
from material contaminated with anthrax. 

Any brushes found in the market which do not bear the name or 
trade-mark of the manufacturer should be regarded with suspicion 
and should be returned to the source from which they were secured 
or should, be disinfected. 

For the sterilization of brushes, the following procedure is believed 
to be effective : 

The brush should be soaked for four hours in a 10 per cent solution 
of formalin (by formalin is meant a 40 per cent solution of formalde- 
hyde). The solution should be kept at a temperature of 110° F. and 
the brush so agitated as to bring the solution into contact with all 
hair or bristles. 

I shall be obliged to you for bringing this information to the atten- 
tion of all those interested. 
Respectfully, 

EuPEET Blue, 

Surgeon General. 

Administration of Arsphenamine and Neoarsphenamine. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington^ April 28, 1919. 

Bureau Circular Letter No. 163. 

Medical officers. United States Public Health Service, and others 
concerned : 

In view of the variations of technique of the administration of 
arsphenamine and neo-arsphenamine at various service clinics, at- 
tention is invited to the following points, careful observation of 
which should reduce the number of reactions from the use of this 
drug. 

The ampule, before opening, should be immersed in 95 per cent 
alcohol for 16 minutes, so as to detect any crack or aperture not pri- 
marily recognizable. (Should such a breach be discovered, the con- 
tents of the afiipule should be discharged.) 

APSPHEN AMINE. 

(1) Solution. — Cold, boiled, freshly distilled water should be used 
in all cases except in the case of " arsenobenzol " made by the Der- 
matological Research Laboratory, in which case hot water is re- 



127 

quired. No more solution should be prepared at one time than can 
be given in 30 minutes. 

(2) Neutralization and alkalinisation of the above solution. — With 
a graduated pipette or bruette add 0.9 c. c. of normal NaOH for each 
0.1 gm. of the drug (i. e., 5.4 c. c. for each 0.6 gm.) . The alkali should 
be added all at once and should quickly convert the acid salt solution 
of arsphenamine into the alkaline salt solution, or the disodium of 
salt of the arsphenamine b^se. The solution of arsenobenzol, which 
is hot, should be cooled before adding the alkali. This represents 
slightly more alkali than just enough to redissolve the precipitate 
formed by the addition of this reagent. 

The alkali used should be standardized against normal acid. 
Normal NaOH is a 4 per cent solution of the c. p. product. However, 
if made on the basis of weight, it may be considerably less than this 
strength ; hence the necessity for titration. It could be made up in 
amount sufficient for a month's use, if kept in a well-stoppered bottle 
and exposed to the air for only a few seconds at a time when using 
the solution. It should be kept in a bottle that has been used for 
NaOH solution for some time, so that all action it might cause on 
the glass has already occurred. Where it is impossible to have this 
made up at the station, it will be furnished upon request from the 
Hygienic Laborator3^ Should the NaOH solution become cloudy 
or contain a precipitate, it should be discarded. , 

(3) Concentration of the dinig. — It is desired to emphasize the 
fact that the concentration of the drug should not be greater than 
0.1 gm. to 30 c. c. of final solution. The practice of using concen- 
trated solution is not only in direct conflict with the instructions on 
the circular, but carries a distinct hazard to the patient. 

(4) Method of injection. — The gravity method only should be 
used. Where several patients are to be injected from the same 
solution, the container for the solution should be graduated. If not 
already graduated, this can be done in a few minutes by sticking 
on a strip of adhesive plaster and making the graduations on this. 
A convenient way to do this is to- have each mark represent 30 c. c. 
with a long mark for each 180 c. c. ; then, if the volume is made up 
so that each 0.1 gm. of drug is contained in each 30 c. c, the doses 
can be given accurately. It is a great convenience to have a glass 
stopcock near the glass tubing which serves as a AvincloAv jvist above 
the needle in order to control the rate of injection. If no stopcocks 
are at hand, the rate can be controlled by the size of the needle and 
the height of the column of fluid. A No. 18 or 20 B. & S. gauge is 
the best size needle. 

(5) Rate of injection. — Operators should pay particular atten- 
tion to the rate of administration and in no case exceed 0.1 gm. of 



128 

drug (30 c. c. of solution) in two minutes. This point is especially 
emphasized because it is believed that excessive rapidity of ad- 
ministration accounts for more unfavorable results in the use of 
arsphenamine than any other one thing. 

NEO-ARSPHENAMINE. 

The principal precautions to be observed in the administration 
of neo- arsphenamine are : 

(1) But a single ampule should be observed at "a time. This drug 
must not be dissolved in bulk to be given to a series of patients. 

(2) Cold water only should be used. 

(3) The dilution should be not stronger than O. I. of the drug in 
2 c. c. of freshly distilled water. 

(4) A very small needle should be used, and the time of injection 
of the dose should be not less than five minutes. 

CAUTION. 

Operators are advised that they will be held accountable for un- 
toward results following the use of arsphenamine and neoarsphen- 
amine in cases where there has been material deviation from the 
outline given above. 

Acknowledgment of receipt of this letter is directed. 
Eespectfully, 

Rupert Blue, 

Surgeon General. 

Instructions Concerning Signature of Officers in the Reserve. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, May 5, 1919. 

Bnrean (Srcnlar Letter No. 164. 

To com/missioned oiftcers and fharmacists, United States Public 
RecHth Service: 

Hereafter all official matter to be signed by reserve officers shall 
be prepared for signature with their grade designation or title and 
immediately followed by the word "Reserve" in parenthesis. All 
correspondence addressed to such officers shall have the word "Re- 
serve "" in parenthesis immediately following their grade designation 
or title. 

Respectfully, 

Rupert Blue, 

Surgeon General. 



129 

Health Education Through Newspaper Articles. 

Treasury Department, 
Bureau of the Public Health Ser"\t:cb, 

Washington^ April 15, 1919. 

Bnrean Circular Letter No. 165. 

Medical Officers, United States Public Health Service : 

The value of suitable newspaper articles in the promotion of 
public health education can hardly be overestimated. For this 
reason the Public Health Service has for some years been mailing 
to newspapers timely articles dealing with the more important 
phases of the subject. It is believed a much wider use would be 
made of these articles by the newspapers if they were handed to 
the editor, managing editor, or city editor by the representatives of 
the Public Health Service in person. This is because so much propa- 
ganda is now being circulated through the mails that the editor has 
little or no time to consider the merits of this mass of material and 
usually consigns it all to the wastebasket. 

Hereafter copies of all the items issued by the bureau's section of 
public health education will be sent to you, and you are directed 
to use your best efforts to secure their publication in the various 
newspapers published in your city. It is important that the articles 
be supplied impartially to all the newspapers. Please, therefore, 
advise the bureau how many copies will be required. 

Visit the editors of the city in which you are located, and endeavor 
to arouse their interest and secure their cooperation in the efforts 
of the service to improve public health. It is hardly probable that 
any editor will withhold cooperation if he is thoroughly acquainted 
with the various health problems confronting the Nation. These 
you can make clear to him in a personal interview when you submit 
the articles already mentioned. Assure the editors of the coopera- 
tion of the Public Health Service that the service will be pleased 
to answer for the readers of their papers all questions relating to 
public health and preventive medicine. 

Rupert Blue, 
Surgeon General. 

Cooperation with Red Cross Concerning Officials of the Service. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, April 30, 1919. 

Bnrean Circular Letter No. 166. 

To co7n7nissioned medical officers, acting assistant surgeons, and 

others concerned: 

There is inclosed herewith a circular issued by the American Red 
Cross, outlining their plan of organization for complying with the 
14330°— 21 9 



130 

request of the Surgeon General of the Public Health Service asking 
for their cooperation and assistance in certain activities pertaining 
to the comfort and welfare of the beneficiaries of the Public Health 
Service, with special reference to discharged soldiers and sailors who 
may be undergoing treatment in our hospitals. 

You are directed to give careful consideration to this circular and 
its provisions, as well as to the copy of the letter of the Surgeon Gen- 
eral of the Public Health Service which is attached; you are in- 
structed to cooperate with the American Red Cross in the perform- 
ance of this work and to offer their representatives all the facilities 
possible at your station to properly carry out the program outlined 
in so far as it is applicable to the hospital under your charge. 

It must be realized that soldiers, sailors, and marines undergoing 
examination and treatment in our hospitals are but recently dis- 
charged from military hospitals where they have been the recipients 
of much kindness from a number of volunteer organizations. Ac- 
tivities of the kind anticipated are wholesome and necessary, and 
the lack of them is likely to breed discontent and dissatisfaction. 
For this reason, the Surgeon General is most desirous for the Red 
Cross to carry on in the hospitals of this service the work which 
has been so ably conducted in the military hospitals. 

It is earnestly desired that every officer of the service give this 
important matter his earnest and sympathetic consideration and his 
cordial support. 

Respectfully, 

J. C. Perry, 
Acting Surgeon General. 



Supplement to Bureau Circular Letter No. 75 — Physical Examination for the 

Coast Guard. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington., May 2Ji., 1919. 

Bnreau Circular Letter No. 167. 

To medical officers of the United States Public Health Service: 

Complaints are frequently received by the bureau relative to the 
inadequacy of the physical examination given persons applying for 
enlistment in the Coast Guard Service. Officers should understand 
that such examinations should be made with great care and that their 
reports should be sufficiently adequate in order that the physician 
who reviews them may have sufficient information upon which to 
base judgment. 

Unless these applicants are examined with sufficient care, it in- 
evitably results later that their physical disability under the stress 



131 

of service work forces them to seek medical and hospital relief, 
greatly to the detriment of the service. 

Attention is invited to the fact that in all cases a chemical exami- 
nation of the urine should be made, and if necessary should be 
supplemented by a microscopical examination. This is a matter of 
too much importance to be neglected. 

E.UPERT Blue, 

Surgeon General. 

Plan of Organization of Districts for Relief to Service Beneficiaries of All 

Classes. 

Treasurt Department, 
Bureau of Public Health Service, 

Washington^ June ^, 1919. 

Bnrean Circular Letter No. 168. 

To commissiooied medical officers., acting assistant surgeons., United 
States Puhlic Health Service^ and others concerned: 
It is directed that the several district offices established for the 

more efficient examination of service beneficiaries shall conform to 

the following general plan of organization : 

1. The district supervisor directs and oversees all activities in his 

district apart from the conduct of the service hospitals located in 

the district. His duties are set forth in his general orders and in 

the several bureau and department circular letters which have been 

issued. 

The district supervisor shall keep the following records of all 

patients examined or treated in his district : 

1. Eecord of examination and disposition of patient (Card A.). 

2. Case record (Card B). 

3. Record of discharge from hospital (Card C). 

4. Card index of all correspondence from all stations in his dis- 
trict, from the Bureau of Public Health Service, and the Bureau of 
War Eisk Insurance. 

5. Folder for each patient containing all information concerning 
him, such as record of physical examination, clinical record while in 
hospital, consultant's record, etc. 

Card A, "Report of examination and disposition of patient," 
should be given a serial number as soon as it is received in the dis- 
trict office. The case record (Card B) should be numbered as soon 
as it is received with the corresponding number on Card A. The 
record of discharge from hospital (Card C) should also be given 
the serial number that has already been given to the same patient's 
Cards A and B. The duplicate of Cards A, B, and C, after being 
given a serPal number, should be immediately forwarded to the 
bureau. 



132 

He shall make the following reports to the Bureau of the Public i 
Health Service : 

BEPOETS OF ACTIVITIES IN DISTRICT. 

1. Weekly: 

Number of cases examined in offices. 
Number of cases sent to tiospital for examination. 
Number of cases sent to hospital for treatment. 
Number of office patients not previously reported. 

2. Monthly: 

Medical officer's report of relief, Form 1922. 

Patients admitted to and discharged from hospital. Forms 8998 and 

1958 (Columns marked " Dates of last continuous service," " Par. of 

Reg. under which admitted," " Extension," may be left blank in 

filling out these reports). 
Monthly schedule of encumbrances. Form 1955. Vouchers covering 

expenditures during month, Forms 1926 and 1949. 
Pay rolls for all officers and employees in his district. 

3. Annual: 

Medical and surgical report of outpatients, Form 1923. 
Medical and surgical report of hospital patients. Form 1924. 

II. The State supervisor oversees and advises the local examiners 
in his respective State. It is intended that this officer shall be an 
aide to the district supervisor and shall serve under his orders only. 
He shall not direct the activities of the local examiner except in so 
far as he may be ordered so to do by the district supervisor. He 
shall report to the district supervisor directly concerning all matters 
in his State. 

III. The local examiner examines all service beneficiaries applying 
to him for treatment of their own volition, or by direction. The 
local examiner in each instance must satisfy himself as to the 
genuineness of the applicant's right to examination and treatment. 
If the applicant requires only out-patient relief and there is no 
service station nearby where he can receive such relief, the local 
examiner is authorized to furnish him treatment, giving him a pre- 
scription if necessary to a local druggist for such medicine as is 
required. Vouchers for prescriptions should be rendered at the end 
of each month on Form 1949, and should bear patient's name and 
prescription number. Copies of prescriptions with prices of each 
marked thereon should accompany such vouchers. 

Where an applicant entitled to treatment requires hospital care, 
it should be furnished in accordance with paragraphs 7 to 10, in- 
clusive, of Department Circular No. 140, dated May 1, 1919. 

Where an applicant is examined in accordance with paragraph 6 
of Department Circular No. 140, dated May 1, 1919, the report of 
physical examination shall be made in triplicate, the original should 
be mailed immediately, direct to the Chief Medical Adviser, Bureau 
of War Risk Insurance, Washington, D. C, the duplicate shall be 



133 

mailed immediately direct to the district supervisor, and the tripli- 
cate filed by the local examiner. 

Card A, " Report of examination and disposition of patient," shall 
be filled out in triplicate, one copy should immediately be forwarded 
to the Chief Medical Adviser, War Risk Insurance Bureau, with 
the report of the physical examination, and the other two copies sent 
to the district supervisor. 

Card B, " Case record," shall be made in duplicate for each appli- 
cant, these cards being retained by the local examiner until the final 
disposition of the case, when the original shall be forwarded to the 
district supervisor and the duplicate filed. 

Card C, " Record of discharge from hospital," should be filled out 
in triplicate as soon as the patient receives hospital treatment; one 
copy should be forwarded direct to the Chief Medical Adviser, Bu- 
reau of War Risk Insurance, and the other two copies to the district 
supervisor. 

Card D, " Hospital admission card," should be filled out in dupli- 
cate whenever a patient is referred to a hospital either for examina- 
tion or for examination and treatment. The original should be given 
to the patient for presentation to the hospital and the duplicate filed. 

Each patient should be given a permit number beginning with the 
unit on July 1 of each year. There should be a series of numbers for 
hospital patients and another series for office patients. 

Vouchers for hospital treatment at other than relief stations should 
be rendered on Form 1926 at the end of each month and forwarded 
to the, district supervisor. Separate vouchers should be provided for 
patients sent to hospital for examination only. All vouchers shall be 
initialed by local examiner and certified by district supervisor. Offi- 
cers in charge of relief stations should render vouchers direct to the 
Bureau of Public Health Service as heretofore. 

When a case is discharged from the hospital the local examiner 
originally ordering the admission shall direct the hospital to furnish 
a complete record of such case during his stay in the hospital, which 
shall be forwarded to the district supervisor. 

Officers in charge of relief stations shall follow the instructions- 
given above for local examiners except that no reports need be 
made to district supervisors of patients other than beneficiaries of 
the War Risk Insurance Bureau; neither shall Cards A and B be 
used for other than these same beneficiaries. Relief certificates and 
hospital permits, Forms 1916 and 1917, should be forwarded to the 
bureau as heretofore. 

No reports shall be made to the Chief Medical Adviser, Bureau of 
War Risk Insurance, except in the case of discharged soldiers, sailors, 
marines. Army and Navy nurses, male and female. 



134 

Letters requesting information regarding treatment and hospitali- 
zation of beneficiaries of the service, including war-risk insurance 
cases, should be directed to the Surgeon General, United States 
Public Health Service. 

Respectfully, Kupert Blub, 

Surgeon General. 



Relative to Purchase of Motor Vehicles' Accessories, Including Oil and 
Gasoline, Also Repair of Motor Vehicles. 

Treasury Department, 
Bureau of Public Health Service, 

W ashing ton^ June 6, 1919. 

Bureau Circular Letter No. 169. 

To commissioned medical officers^ acting assistant surgeons^ pharma- 
cists^ United States Public Health Service^ and others concerned: 
Amending Bureau Circular Letter No. 161, dated April 15, 1919, 

you are advised: 

1. That requisitions made by officers of the service for accessories, 
spare parts, and repairs for motor vehicles will be honored by any 
local Motor Transport Corps repair shop, supply depot, or Motor 
Transport Corps officer, the cost of such supplies or repairs to be re- 
imbursed the War Department by transfer of funds. 

2. That oils and gasoline required for motor vehicles furnished the 
stations of the service can not be retailed by zone supply officers or 
supply depots of the Quartermaster Department, but that requisitions 
for such supplies, sent through the bureau, will be honored by the 
Quartermaster Department to be furnished in bulk, the cost thereof 
to be reimbursed by the transfer of funds. 

3. You are instructed to ascertain whether there would be any con- 
siderable saving in purchasing oils and gasoline through local dealers. 
If there is a considerable saving in purchasing through said depart- 
ment, steps should be taken to have proper tanks installed at your 
station for the storage of said supplies. Proposals for same should 
be taken by poster and circular letter advertisement, and forwarded 
to the bureau with your definite recommendation. 

Respectfully, 

Rupert Blue, 

Surgeon General. 



135 

Lettering of Official Motor Vehicles and Use for Official Business Only. 

Tkeasxtrt Department, 
Bureau or Public Health Service, 

W ashington, June 6^ 1919. 

Bnrean Circular Letter No. 170. 

To C oirmiissioThed Medical 0-fficers^ Acting Assistant Surgeons^ 
United' States Public Health /Service, and others concerned: 
Whenever a motor vehicle is transferred from the Army to the 
Public Health Service the words " United States Army," the Army 
serial number, and other lettering shall be painted out, and there 
should be substituted therefor the words " U. S. Public Health Serv- 
ice — For official business only." On the passenger cars there words 
should be placed on a door on each side. The letters should not be 
over one inch in height. 

Passenger cars shall not be employed for personal use, and at 
camps and other places whenever it is necessary to transport persons 
other than patients or employees of the Government, a special re- 
quest shall be made in writing to the medical officer in charge for 
each trip. Such requests after being approved by the medical 
officer in charge shall be placed on file at the station. Medical officers 
in charge of stations are responsible for the use of these passenger 
cars and, except where they feel such use is of an emergency nature 
and great inconvenience and discomfort would be caused by refusing 
the use thereof, they shall not permit them to be used for other than 
official purposes. 

A detailed description of each motor vehicle in the custody of 
service officers should be immediately made to the bureau, where- 
upon a serial number will be assigned to each such vehicle, and that 
number should be placed upon the vehicle in a suitable place. There- 
after, all reference to motor vehicles, in addition to the usual de- 
scription, should be made by the serial number to be given, of 
which officers will be immediately advised. 

Many of the States, Territories, and municipalities provide for 
registration of motor vehicles and impose a special tax through fees 
for permits, or licenses, or for identification tags. Officers are in- 
structed as follows upon this subject : 

A. It is not necessary to procure such license to cover the use of 
motor vehicles owned by the Government or operated exclusively 
by officers or employees of the governmental service for official pur- 
poses only, and public funds should not be expended for any such 
license or identification tags. Licenses, identification tags, or plates, 
furnished without charge, in noway involving an expenditure, 
should be accepted and placed in use. 



136 

B. Should there be any interference by local authorities with re- 
spect to registration, special tax, or official operation of a service 
motor vehicle, the service officer should give full information as to 
the ownership and use of the vehicle, and instructions under which 
operated, and should courteously request that there be no further 
interference. Should the request be denied, full report should be 
immediately made to the bureau for such legal action as may be 
deemed necessary. 

C. Motor vehicles privately owned by service officers come strictly 
within the local laws and regulations and the use thereon of marks 
indicating that they are for governmental use, such as "U. S. P. 
H. S.," is prohibited. 

Respectfully, 

Etjpert Blue, 

Surgeon General. 



Instructions Concerning Discipline to be Maintained at All Service Hospitals. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, June 10, 1920. 

Burean Circular Letter No. 171. 

To commissioned medical ojjicers, acting assistant surgeons, and 

others concerned: 

In view of the fact that such a large proportion of the beneficiaries 
of the service is made up of war-risk insurance patients and that these 
men have very recently been discharged from the military forces, 
it has become necessary to direct that certain changes be made in 
the conduct of the hospitals of the service. Practically all these 
patients have shown a very strong desire to get away from every- 
thing military and it is believed that in order for the service to 
prove of most benefit to them that this desire must be gratified, in 
part, at any rate. 

It is not necessary to institute military form and custom in order 
to maintain discipline, nor is it desirable. It is absolutely essential 
for the proper conduct of a station that discipline be maintained 
at all times, but it is not necessary that military regulations be 
adopted or enforced in order to maintain it. 

All hospitals of the service should conform to the civilian type 
rather than the military and all patients should be made to feel that 
they are not under hard and fast rules. During the time that an 
officer is present in the wards, whether for the purpose of making his 
usual rounds or whether for inspection, quiet and order should be 
maintained but patients should not be required to stand at attention 
or to salute. The bureau realizes, of course, that the officer in charge 



137 

of a station must have tlie power of instituting various disciplin- 
ary measures in order that the station may be properly conducted, 
but these rneasures should be decided in each individual case. In 
some cases it may be necessary to adopt stringent measures, but it is 
believed that in the majority of instances these men can be reasoned 
with, and that minor forms of punishment, such as remaining in 
bed after having their clothes taken from them, etc., will often give 
the desired result. Occasionally dismissal may become necessary, 
and when it is resorted to the patient should be informed that he 
will again be admitted to the hospital at any time he is in need 
of hospital treatment, provided he is willing to conduct himself in 
accordance with the rules of the hospital. In case of dismissal for 
disciplinary reasons, a report should be sent to the bureau giving 
his hospital number, name, age, the time he was admitted to the 
hospital, date of discharge, and the reasons for his dismissal, and 
if he was informed that he could be readmitted if he would con- 
form to the hospital regulations. 

Ambulant patients may be allowed to visit friends and relatives 
in the near-by towns or the towns themselves, but shall return to the 
station at a reasonable time. A patient should not be allowed to 
leave the reservation, however, without permission of the officer in 
charge of the ward, and a pass signed by this officer should be re- 
quired for every absence. 

Visitors should be allowed to enter the wards only on Tuesdays 
and Thursdays, as at present. In certain cases they should be 
allowed to come in on other days, but only for a very definite reason 
and when permission for the visit is obtained from a medical officer 
on duty. Ambulant cases should be allowed to receive visitors in 
the reception rooms at any time during the day. It is believed that 
if visitors are allowed to see the patients more often that the prac- 
tice of their leaving the reservation will in large part cease. 

Since the policy of employing female nurses has been universally 
adopted in the service conditions have changed materially. These 
women are specially trained and are selected with considerable care, 
and the regulations relating to attendants should not be applied to 
them in the matter of muster, etc. The chief nurse, who is care- 
fully chosen, should be entirely responsible for the nurses, all of 
whom should be directly under her supervision. She alone should 
direct them in all matters relating to discipline and conduct, and 
whenever any officer has any complaint concerning a nurse it should 
be made to her. There is no intention, of course, of relieving a nurse 
from her responsibility to the officer in charge of a case for carrying 
out all his orders concerning treatment, etc., but all other matters 
should be conducted by the chief nurse. The chief nurse is re- 



138 

sponsible directly to the medical officer in charge for the conduct 
and efficiency of the nurses under her charge. 

Nurses should make all their requests, complaints, etc., to the chief 
nurse, and the medical officer in charge should always consult her in 
such matters. 

The matter of social intercourse between officers and nurses is a 
very delicate one, calling for considerable tact on the part of both. 
It is natural when men and women are thrown together so constantly 
that friendships should develop, and there is no reason far discour- 
aging them, but everyone should be exceedingly careful that there 
is no reason for criticism or comment by anyone on the station or in 
the community. The medical officer in charge should be especially 
careful in this regard. 

One of the most important matters connected with the manage- 
ment of a station is that of inspections. Reference is not made to 
the formal inspection required by the regulations, but to the probably 
more important informal, unannounced inspection made at frequent 
intervals and at any time during the 24 hours. It is absolutely essen- 
tial for the proper conduct of a station that the officer in charge 
shall be thoroughly familiar with everything that occurs in connec- 
tion therewith. Of course, it is not expected that he shall look 
after the details, for they must obviously be left for his various 
assistants. He should, however, go into the wards frequentl}^ and 
see that the duties are being properly performed and that everything 
is clean and orderly. This should not be left to others but should 
instead be regarded as one of the most important duties of the 
officer in charge. These inspections should be informal and always 
unannounced. 

The medical officer in charge should at all times be ready to receive 
any person on his reservation, whether officer, nurse, attendant, 
patient, or laborer, in order that they may have an opportunity to 
express their complaints, etc. If subordinates feel that they can 
at any time see a superior and that they will be courteously and 
sympathetically received a great many of the difficulties and much 
of the dissatisfaction will immediately be forgotten. 

A hospital is fundamentally and primarily a place for the treat- 
ment of the sick, but in the majority of instances it is more, and 
for the time being a home. Every effort should therefore be made 
in order to make the place attractive, homelike, and efficient. 
Patients should be made to feel that no effort will be spared to make 
them comfortable and content and that all other interests are sub- 
servient to this end. When physicians, nurses, and attendants are 
thoroughly imbued with the idea of doing everything possible for 
the welfare of their patients all other matters become far easier and 
more pleasant. 



139 

It is the intention of the bureau that the hospitals of the service 
shall be conducted on the highest plane possible and no effort will 
be spared to make them the equal of any institution, either civil or 
military. 

It should be understood that nothing in this letter is intended 
to apply to any one class of beneficiaries rather than another, as all 
patients, whether merchant seamen, civil employees of the United 
States, Coast Guard, or War Eisk Insurance, should receive the 
same consideration. 
EespectfuUy, 

Etjpert Blue, 

Surgeon GeTieral. 



Nomination and Appointment of Nurses. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ June 19^ 1919. 

Bureau Circular Letter No. 172. 

Medical oificers in charge of hospitals of the United States Public 

Health Service and others concerned: 

The medical officers in charge of the hospitals of the service are 
advised that the service has established in the bureau a section de- 
voted to the organization of a nursing corps for this service, in charge 
of a superintendent of nurses. The nurses of this service are secured 
through the headquarters of the American Eed Cross in Washington. 

As a general policy the bureau expects, first, that all nurses of 
whatever grade will be appointed by the Surgeon General upon the 
recommendation of the superintendent of nurses; second, that chief 
nurses will be assigned by the Surgeon General upon the recom- 
mendation of the superintendent of nurses. Unless there are very 
urgent reasons to the contrary this general policy will not be devi- 
ated from, and medical officers should never assume the authority to 
do so unless they have specific instructions in each individual case. 

Should circumstances arise where it may become necessary to 
appoint a chief nurse or nurses not in conformity with this general 
policy such assignments or appointments will always be purely 
of a temporary nature. Conformity with these instructions is neces- 
sary to avoid inevitable confusion, and medical officers are expected 
in future to observe these instructions under all circumstances. 

EuPERT Blue, 
Surgeon General. 



140 

Dietitian's Service. 

Treasuet Department, 
Bureau of the Public Health Service, 

Washington^ June 17, 1919. 

Bnrean Circular Letter No. 173. 

Medical ojjicer in charge United States Marine and Public Health 

Service hospitals: 

The appointment of dietians to the hospitals of this bureau makes 
it necessary to formulate a general statement defining the dietitian's 
place and duties. While it is realized that such a general outline 
will require some modification by medical officers, it is intended that 
the principles involved shall not be radically modified without 
authority. 

The value of the dietitian to the hospital is largely determined by 
the degree to which cooperative relations are established. Conferences 
at regular intervals, in which the medical officer in charge meets 
with the head dietitian, chief nurse, and mess supply officer, or other 
coordinating officials, are recommended. 

1. Relation of dietitian to hospital staff. — The dietitian is respon- 
sible, so far as her professional work is concerned, to the officer in 
charge of the hospital. She is expected to work in coordination with 
such other officials, including the chief nurse, as may be designated 
by the officer in charge. The efficiency of the dietitian's services will 
be determined from reports of ward surgeons who. are directly re- 
sponsible for the prescribing of diets. The chief nurse will also 
render a monthly statement of the efficiency of the service of foods. 
The dietitian has .social status equal to that of the chief nurse, but 
subject at all times to such regulations and restrictions as may be 
in force governing all nurses in the service of the hospital. 

2. Status. — The dietitian is civil scientific employe of the bureau, 
and is not to be placed on the same basis with cooks and maids. To 
do so is an injustice to her and a disadvantage to the hospital. When 
two or more dietitians are employed at a station, one shall be desig- 
nated as head dietitian, and upon recommendation may be granted 
$5 per month additional pay. 

3. Duties. — {a) Of the head dietitian: Reports to the chief nurse 
or ward surgeon deficiencies of service found in wards in order that 
these may be corrected through proper channels. Reports deficien- 
cies of preparation and service found in the mess hall and kitchen 
to the medical officer in charge, or such other official as may be 
designated by him. Inspects serving of food in all wards and is re- 
sponsible for its preparation and service. Has general charge of all 
diet kitchens and assigns the work of her assistants. Is responsible 
for the planning of all patients' menus, but confers with mess or 



141 

purchasing officer concerning market conditions before approving 
menus. 

(&) Of the dietitians: Have immediate supervision of the prepa- 
ration of food in the general patients' mess, sick officers' mess, and 
nurses' mess (if desired by the medical officer in charge). They also 
have charge of the filling of the food carriers. Have immediate su- 
pervision of general and ward diet kitchens. Plan menus for ap- 
proval of head dietitian or in conference with mess or purchasing 
officer in the absence of a head dietitian. Have direct responsibility 
for the preparation of diets, and should be provided with sufficient 
help to relieve them of the details of this work. Visit wards to con- 
fer with ward surgeons, nurses, and when necessity demands with 
patients regarding special diets. 

4. EquijJment. — The head dietitian should have an office provided 
with a desk and such other equipment as may be deemed necessary, 
the office to be located in close proximity to the mess department or 
diet kitchen. 

KuPERT Blue, 
Surgeon General. 

Expenditures — Relief of Patients of War Risk Insurance Bureau; How and 
When Incurred; How Payable. 

Treasury Department, 
Bureau of Public Health Service, 

Washington, June 18, 1919. 

Barean Circular Letter No. 174. 

Medical officers in charge, United States Marine and Public Health 
Service Hospitals. 

1. In order that there may be no misunderstanding regarding the 
service to which expenditures are chargeable in the matter of fur- 
nishing relief to beneficiaries under the War Risk Insurance Bureau, 
as directed in the act of March 3, 1919, entitled "An act to authorize 
the Secretary of the Treasury to provide hospital and sanitorium 
facilities for discharged sick and disabled soldiers, sailors, and 
marines," the following information is furnished. 

2. The expenditures chargeable to appropriations under the con- 
trol of the Bureau of War Risk Insurance : 

{a) Travel to place of examination and return to home. (Par. 11. 
Treasury Department Circular No. 140, May 1, 1919.) 

(&) Travel from hospital to home if incidental to treatment or 
after recovery. 

(e) Hospital expenses while being examined. (Par. 11, Treasury 
Department Circular 140.) 

{d) Wages lost while examination is being made. (Par. 11, Treas- 
ury Department Circular 140.) 



142 

(e) Expense of treatment at hospitals or contract stations of the 
Public Health Service establishment before March 3, 1919. (Par. 14, 
Treasury Department Circular 140.) 

(/) Expenses for artificial limbs and prosthetic apparatus gen- 
erally. (Par. 15, Treasury Department Circular 140.) 

(g) Any expense of examination by a physician not an officer of 
the Public Health Service. 

(h) Expense of home treatment. (Par. 10, Treasury Department 
Circular 140.) 

(i) Expense for special preparation and transportation of dead 
body for purpose of interment at former home. (Sec. 2, par. 14, 
Public Health Service Unnumbered Circular Letter May 9, 1919, 
entitled "Instructions to officers.") 

(j) All expenditures incurred for relief of War Risk Insurance 
Bureau beneficiaries prior to March 3, 1919. 

3. Expenditures chargeable to appropriations under the control 
of the Public Health Service : 

(a) Medical examination by officers of the Public Health Service. 
(Par. 6, Treasury Department Circular 140.) 

(b) Ward treatment in hospital when ordered by Public Health 
Service officer. Convalescent care may be provided under similar 
conditions. (Pars. 8 and 9, Treasury Department Circular 140.) 

(c) Out-patient and hospital care and travel from one hospital 
to another after patient begins receiving treatment by Public Health 
Service, exclusive of treatment at marine hospitals or contract sta- 
tions established before March 3, 1919. (Pars. 12 and 14, Treasury 
Department Circular 140.) 

(d) Expenses of burial, when dying in hospital, not exceeding 
$100. (Sec. 11, act of Mar. 3, 1919, and first section of par. 14, Bureau 
of Public Health Service Unnumbered Circular Letter May 9, 1919.) 

EupERT Blue, 

Surgeon General. 



Distribution of Circulars and Printed Matter to Field Stations Furnishing 
Relief Under the Direction of the Division of Marine Hospitals and Relief 
Through Division Officer. 

Treasury Department, 
Bureau of Public Health Service, 

Washington, June 24, 1919. 

Bnrean Circular Letter No. 175. 

To officers in charge of divisions, medical officers in charge, and others 
concerned : 

The following is a list of all circulars and printed matter bearing 
kon the subject of relief to be furnished to beneficiaries of the War 



143 

Eisk Insurance Bureau, and other beneficiaries of the service, and 
all officers are hereby notified that in the future similar matter will 
be distributed through the supervisors of each district. 

Supervising officers are requested to immediately send in letter 
request for a supply of such material as is necessary in their districts 
and the same will be forwarded with as great expedition as 
practicable. 

District officers should make timely letter requests from time to 
time in order that they may receive from the bureau ample supply 
of the circulars and printed matter to furnish to officers in their 
respective districts, as the same will not hereafter be furnished 
direct by the bureau, except under extraordinary conditions. 

1. Department circular No. 140, May 1, 1919, with six inclosures, 
viz: War risk insurance act; war risk circular relative to dental 
work ; war risk scheme of report of physical examination ; war risk 
application form (No. 526) ; Public Health Circular Letter No. 159, 
March 20, 1919 ; memorandum regarding transportation requests. 

2. Act of March 3, 1919. 

3. Public Health Service circular letter of May 6, 1919, " Instruc- 
tions to examiners." 

4. Public Health Service circular letter of May 9, 1919, " Instruc- 
tions to officers." 

5. Nomenclature of diseases and conditions. 

6. Public Health Service circular letter of April 17, 1919, " Com- 
pensation of consultants." 

7. Public Health Service Circular Letter No. 166, April 30, 1919, 
" Cooperation with Red Cross concerning officials of the service," 
with one inclosure, viz : Red Cross circular letter of April 11, 1919 ; 
" Red Cross Service in United States Public Health Service 
Hospitals." 

8. Public Health Service Circular Letter No. 34, April 11, 1914, 
"Information and instructions respecting purchases, contracts, pro- 
posals, and vouchers." 

9. Complete list of relief stations and officers in charge. 

10. List of districts and officers in charge — Unnumbered circular 
letter May 9, 1919, Division Marine Hospitals and Relief. 

11. Maps showing location of districts. 

12. Further instructions to examiners — Bureau unnumbered circu- 
lar letter May 26, 1919. " 

13. Supplement to Bureau Circular Letter No. 75 (May 24, 1919), 
Physical examination for Coast Guard. 

14. Plan of organization of districts — Bureau Circular Letter No. 
168, June 4, 1919. 

15. Circular Letter No. 174, June 18, 1919, " Expenditures." 



144 

16. Bureau Circular Letter No. 169, June 6, 1919, Relative to pur- 
chase of motor vehicle accessories. 

17. Bureau Circular Letter No. 170, June 6, 1919, Lettering of 
official motor vehicles. 

18. Circular Letter No. 171, June 10, 1919, Instructions concern- 
ing discipline. 

Rupert Blue, 
Surgeon General, 



Additional Compensation at the Rate of $240 Per Annum. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ June 24, 1919. 

Burean Circular Letter No. 176. 

Medical oiflcers in charge .^ and others concerned: 

Section 7 of the legislative, executive, and judicial act, approved 
March 1, 1919, provides that during the fiscal year 1920 all civilian 
employees of the United States Government receiving an annual 
compensation not in excess of $2,500 shall receive additional com- 
pensation at the rate of $240 per annum. 

Provided, first. That employees receiving an annual compensation 
at a rate greater than $2,500 shall receive additional compensation 
at such a rate as to make the total compensation not more than 
$2,740. 

Second. That employees receiving less than $400 per annum shall 
receive an increase at the rate of 60 per cent of the monthly compen- 
sation. 

Third. That where an employee has received during the fiscal year 
1919 or shall receive during the fiscal year 1920 an increase in excess 
of $200 per annum, or where an employee has entered the service 
since June 30, 1918, no increase shall be paid until a certificate has 
been made as to the ability and qualifications of the employee such 
as would justify the increased compensation. This certificate will 
be made by the medical officer in charge subject to the approval of 
the head of the department. 

Fourth. Employees whose services are utilized for brief periods 
or whose employment is of an intermittent nature, will not be en- 
titled to the increase of compensation. 

Fifth, Persons whose duties require only a portion of their time, 
but who hold themselves in readiness to work whenever called on, 
will be entitled to the increase. 

Sixth. Persons employed under cooperative arrangements, and 
who receive a part of their pay from outside sources, will not be 



145 

entitled to the increase of compensation. This applies particularly 
to collaborating epidemiologists who are connected with State boards 
of health. 

Seventh. As some time must elapse before an intelligent estimate 
can be made of the ability and qualifications of an employee, the 
letter recommending the increase should not be written until the 
expiration of two weeks after entrance on duty. Those employees 
who are separated from the service within that time will receive no 
increase. All letters must be written promptly at the expiration of 
two weeks' service and must give the date upon which the increase 
becomes effective, which will be the date of appointment. Recom- 
mendations for increases submitted at a later date will be made 
effective from date of letter. 

Eighth. All recommendations for appointment must be made at 
basic rate of pay. The increase is considered separately and is paid 
from a different appropriation. 

Ninth. No additional recormnendations are necessary for those 
employees now receiving the additional compensation under the act 
of July 3, 1918. 

This circular supersedes bureau circular letter No. 134, dated July 
19, 1918, as to rate of increase. 

Pay-roll Forms Nos. 1948, 1952b, and 1952c will be used in the same 
manner as during the fiscal year 1919. 

EUPERT BlTJE, 

Surgeon General. 

Base Pay for Appointees, Public Health Service Hospitals. 

Treasury Department, 
Bureau or Public Health Service, 

Washington, July 5, 1919. 

Bnrean Circular Letter No. 177. 

To medical officers and others concerned, United States Public Health 
Service : 

1. The base pay for persons nominated for employment by the 
Public Health Service in its hospitals shall be the prevailing rate 
for similar services in the locality, less $20 monthly. 

2. The reason for this decision is that new appointees deemed to 
be paid the additional compensation of $20 monthly provided by 
Congress, commonly called the " bonus," and in order that they may 
not receive a premium of $20 over the prevailing wage scale, it is 
necessary that the base pay be reduced accordingly. 

3. Due consideration must be given to the furnishing of subsistence 
and lodging in deciding upon the proper salary for any given class 

14330°— 21 10 



146 

of work. Many recent nominations have been made at excessive 
salaries, and the purpose of this circular is to make it clear that the 
bureau will not consider such nominations. Where the salary appears 
high, a detailed explanation must accompany the nomination. 

4. Owing to the increased work now imposed upon the service, it 
is earnestly requested that the terms of this circular be strictly 
observed, as the returning of nominations for adjustment adds largely 
to the work. 

5. Following is a list of average monthly base salaries, including 
lodging and subsistence, it being understood that there may be some 
variation therefrom in different localities, owing to local conditions : 



Attendants $35 

Waiters and waitresses 30 

Executive clerks 130 

Laundresses 25 

Watchmen 40 

Chauffeurs 50 

Nurses ' — 60 

Dietitians 80 



Orderlies $40 

Cooks 60 

Maids 20 

Telephone operators 30 

Elevator conductors 35 

Stenographers and typists 65 

Chief nurses 80 

Clinical clerks 80 

Rupert Blue, 

Surgeon General. 



Record of Personnel for Bureau. 



Treasury Department, , 
Bureau of the Public Health Service, 

Washington, July 1£, 1919. 

Bureau Circular Letter No. 178. 

To Tnedical officers in charge of Public Health Service stations: 

Attention is invited to the fact that many reserve officers, acting 
assistant surgeons, and other personnel have been lately ordered to 
duty at stations of the service. In so far as practicable the record 
of all this personnel has been carefully considered by the bureau, 
but it is possible that in some cases their services will not measure 
up to their records. You are therefore directed to consider the 
qualifications of all such personnel, with a view to advising the 
bureau as to their qualifications, especially as to whether or not in 
your opinion their services are satisfactory and as to whether they 
would be better fitted for duty at some other station in the same or 
in a different capacity. 
Kespectfully, 

Rupert Blue, 

Surgeon General, 



147 

Examination of Cases for Federal Board for "Vocational Education. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ August 28, 1919. 

Bureau drcnlar Letter No. 179. 

To medical ojflcers of the United States Public Health Service: 

1. Under the provisions of the war-risk insurance act, discharged 
soldiers, sailors, marines, and nurses are not entitled to the benefits 
of that act unless discharged subsequent to October 6, 1917. Under 
the provisions of the legislation governing the Federal Board for 
Vocational Education, however, this is not the case, and persons dis- 
charged previous to that date are still entitled to the benefits of that 
board. Under these circumstances medical officers are requested to 
make for the Federal Board for Vocational Education the neces- 
sary physical examinations in such cases, when properly requested 
by officers of the Federal board. 

2. Local officers of the Federal Board for Vocational Education 
occasionally request examinations on special forms of their service, 
which forms are sometimes highly elaborate. The Public Health 
Service is informed by the Federal Board for Vocational Educa- 
tion that requests of this character are not necessary, and the usual 
examination made by officers of this service in the case of war-risk 
insurance beneficiaries is sufficient for the needs of the Federal Board 
for Vocational Education. These special forms may, therefore, be 
disregarded. 

Kupert Blue, 

Surgeon General. 



Relative to Handling of Food, Dishes, or Other Articles by Patients 
Suffering From Communicable Diseases. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, July 11, 1919. 

Bureau Circular Letter No. 180. 

To commissioned medical officers, acting assistant surgeons, United 
States Public Health Service, and others concerned: 
You are advised that convalescent patients, or persons suffering 
from communicable diseases, should not be permitted to handle food, 
dishes, or other articles used by other patients. Your attention is 
invited to a copy of a similar letter sent to all marine hospitals, 
dated February 25, 1919, regarding the management of patients suf- 
fering from venereal diseases. These instructions should be followed 
in other hospitals of the service. 

Eespectfully, Eupert Blue, 

Surgeon General, 



148 

War-Risk Patients Treated in District Where They Reside — Exception as to 
Mental and Neuropsychiatric Cases. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, July 23, 1919. 

Bureau Circular Letter No. 181. 

To the medical oiftcers of the United States Public Health Service 
and others concerned : 

1, It is hereby directed that hereafter no war-risk patients shall 
be sent for treatment to hospitals outside of the district where they 
reside, except when the approval of the Surgeon General of the Pub- 
lic Health Service or of the Chief Medical Adviser of the Bureau of 
War Risk Insurance has been previously obtained. 

2. Mental and neuropsychiatric cases are excepted from this rule. 

Rupert Blue, 
Surgeon General. 

Care of Nervous and Mental Cases Beneficiaries of United States Public 

Health Service. 

Treasury Department. 
Bureau or the Public Health Service, 

Washington, July 30, 1919. 

Bureau Circular Letter No. 182. 

To district supervising officers, United States Public Health Service, 
and others concerned : 
The following general instructions will serve as a guide to the 
procedures to be followed in caring for mentally disabled claimants 
of the War Risk Insurance Bureau, and other beneficiaries of the 
Public Health Service. These instructions are supplementary to 
the procedures outlined in Bureau Circular Letters 140 and 168 and 
other directions, and the latter should be followed as heretofore. 

A. HOSPITAL care. 

1. Special Hospitals, United States Public Health Service. 

(a) U. S. P. H. S. Hospital, Dansville, N. Y., exclusively for in- 
sane patients. Furthermore, it is primarily intended for but two 
classes of insane patients : Firstly, those who have no legal settle- 
ment or residence in any State ; secondly, those whose legal residence 
is in a State that does not provide proper care and treatment for its 
insane patients. 

(5) U. S. P. H. S. Hospital, East Norfolk, Mass., intended ex- 
clusively for epileptic patients. 



149 

(c) U. S. P. H. S. Hospital, Waukesha, Wis., reserved exclusively 
for psychoneurotic patients, who will be generally referred for 
treatment without legal commitment such as is necessary for the 
insane. 

District officers and their representatives will note that a careful 
diagnosis is of the greatest importance in the proper distribution of 
patients to these three special hospitals. Each hospital should be 
informed in advance that a patient is being referred. 

2. State Hospitals for the Insane. 

(a) It is the intention of the Bureau of Public Health Service and 
the Bureau of War Risk Insurance to utilize as far as possible the 
existing hospital and out-patient facilities of the public institutions 
for the insane that reach a sufficiently high level of excellence. 

A provisional list of the several States with the disposition of 
insane beneficiaries (claimants on the War Risk Insurance Bureau) 
residents of these States, is exhibited in Appendix A. 

(&) A list of State institutions in your district, together with 
their location and the name of the superintendent or managing offi- 
cer, will be found in Appendix B. 

(c) A copy of the State laws governing the commitment of the 
insane will be found for each State in your district in Appendix C. 

{d) The district supervisors or their representatives, as opportu- 
nity offers, should visit the several State institutions within their 
district, and render reports of their observations to the Public Health 
Service and to the chief medical adviser of the War Risk Insurance 
Bureau.^ There is suggested herewith a few specific points for in- 
vestigation at State hospitals. 

(1) Hospital accommodations. 

Provisions for day and night space for patients; separation of 
tubercular patients ; facilities for care of infirm and sick patients ; ac- 
commodations for convalescent patients; management of custodial 
cases ; management of untidy, noisy, or destructive patients. 

Also note heating and lighting of hospital, sewage disposal, fire 
protections and hazards, and other noteworthy details. 

(2) Mental clinics : Periodic staff meetings to discuss cases in hos- 
pital. Methods and thoroughness of treatment of ordinary insane 
cases. Size of staff relative to number of patients, and classification 
of attendants and nurses, and whether or not there is a training 
school. General attitude of staff. Interest in work of institution, 
etc. Whether or not an " out-patient " clinic is maintained to follow 
up discharged cases, which branch might merge into the 

(3) Social service branch of the hospital's equipment: It is most 
desirable in any well rounded out scheme of mental treatment that 
the discharged patient should be followed to his home. The suit- 



150 

ability of the home environment for a recently discharged mental 
case should be carefully investigated. If found unsuitable for the 
patient's best interests, steps should be taken to select a more suitable 
environment by the social service branch. The War Risk Insur- 
ance Bureau and the Bureau of Public Health Service should be kept 
informed of what measures are advised by the social service branch, 
so that suitable action can be taken to follow this advice. 

(4) Of equal importance to the community and to the patient is an 
adequate scheme of vocational therapy. Not only may the burden of 
insane wards be, in a considerable measure, removed from the com- 
munity, but the patients themselves may be greatly benefited. 

(5) With this in mind, a comparison should be observed by the 
district officer between agricultural State hospitals and those making 
little or no attempt along this line. 

(6) As a well-balanced diet is of considerable significance in the 
treatment of the insane, the district officer should make careful in- 
quiry into this department. Needless to say, the most obvious indi- 
cation of improper diet is manifest in the symptom complex of pel- 
lagra. But less evident results of improper diet are of equal or 
greater significance as an index to the rational treatment of mental 
cases. 

(7) Where possible, copies of forms of clinical records, statistics, 
etc., should be forwarded to the Bureau of Public Health Service and 
the War Risk Insurance Bureau. 

(8) Laboratory, nursing, and other departments should be care- 
fully observed. 

3, General hospitals with psychopathic wards or with facilities for 
such. 

(a) When communicating with or inspecting general hospitals, 
the bureau specially desires that the district officers or their repre- 
sentatives keep in mind adaptability of such institutions to the care 
of nervous or mental cases. There are a number of reasons in mind in 
making this point. Firstly, there is the immediate problem of the 
temporary disposition of nervous or mental cases requiring care over 
the period of diagnosis or observation or who are awaiting classifi- 
cation and final distribution to special P. H. S. hospitals, State insti- 
tutions, or authorized hospitals. Secondly, the bureau is an exponent 
of the policy that all general hospitals should have a potential 
psychopathic ward as a part of the ordinary equipment of the hospital. 
Therefore, it is desired to make avail of this opportunitj'^ for gather- 
ing information as to the attitude with which most general hospitals 
regard this proposition. 

(5) A later communication will give in detail a number of rea- 
sons why general hospitals should care for mentally disabled civilians 
as well as for men discharged from the service. 



151 

(o) A list of the general civil hospitals in your district that have 
signified a willingness to accept either general nervous, insane, or 
epileptic cases will be found in Appendix D. It is important that 
you confer with the managing officer or superintendent of these 
hospitals at your earliest convenience, and ascertain the facilities 
that are provided for such cases. 

(d) It should be understood that at the present time the bureau 
does not contemplate more than a temporary residence of any of its 
neuropsychiatric beneficiaries at any general hospital. Therefore 
cases will be sent to these hospitals only while undergoing diagnosis, 
or for temporary observation, or while awaiting transference to the 
institution where they are to receive systematic or prolonged treat- 
ment. 

4. Private sanitariums, etc. 

The bureau does not desire at the present time to establish a policy 
of sending neuropsychiatric beneficiaries to private sanitariums for 
systematic or prolonged treatment; therefore, cases will be sent to 
such institutions for treatment only in exceptional instances, and 
only upon specific authorization by the bureau. 

5. Jails, prisons, aimsnouse, etc. 

Under no circumstances should a neuropsychiatric claimant of 
the War Risk Insurance Bureau be confined by a representative of the 
Public Health Service or the War Risk Insurance Bureau, in a jail, 
prison, or county almshouse, pending commitment to hospital. Bills 
for such care will not be honored by either the War Risk Insurance 
Bureau or the Public Health Service. Immediately upon gaining 
knowledge that a claimant is so confined, steps should be taken to 
release the claimant, who should be sent to a proper institution for his 
observation or care (e. g. general hospital with psychiatric pavilion, 
nearest State hospital. Public Health Service hospital with psychiatric 
pavilion) . The ordinary county poor farm is not properly equipped 
for the treatment of mental cases and is manifestly an unsuitable 
place for the care of such cases. (See par. 6, p. 4) 

B. INSANE PATIENTS. 

1. Commitment. 

In general, in any emergency, an insane patient should be com- 
mitted to the State hospital nearest his home. 

{a) To State hospitals. The directions governing the admittance 
of claimants to State hospitals as set forth in Appendix E must be 
closely observed and followed by district officers or their repre- 
sentatives. 

(6) To Dansville. Cases sent to U. S. P. H. S. Hospital, Dans- 
ville, N. Y., must be committed under the Statutes of the State of 
New York governing the admission of such cases. The medical 



152 

officer in charge of this hospital will arrange for commitment upon 
the arrival of the patient. 

2. Cost of commitment of the compensable insane to State hospitals 
is a proper charge against the War Eisk Insurance Bureau and when 
such a procedure is followed a properly itemized bill should be 
submitted for payment. 

3. The expenses for the care and treatment of such cases within 
State institutions is a proper charge against the War Risk Insurance 
Bureau and arrangements have been made with the State hospitals to 
submit bills for such expense. The chief legal advisor should 
be notified in writing of the disposition of each case, giving claim 
number and the date of admission to a special hospital. 

4. Transportation— Attendants. 

Transportation to hospitals from place of commitment or in cer- 
tain cases from one hospital to another, is authorized by the Public 
Health Service. If the patient requires an attendant while travel- 
ing, transportation for the attendant is also authorized by the Pub- 
lic Health Service. Furthermore, the return transportation of the 
attendant is provided for by the Public Health Service. A relative 
of the patient should be used as the attendant wherever possible. Oc- 
casionally, in extreme cases, two attendants will be required, and in 
such instances their transportation is authorized by the Public 
Health Service. The district supervisor should request authority 
for travel of attendant by letter or telegram. In those cases where 
it is not possible to secure the services of an attendant already an 
employee of the Government, an attendant must be officially nomi- 
nated as a temporary attendant in the Public Health Service for the 
required number of days, at a per diem salary, by the district su- 
pervisor, or his representative. 

5. Clinical history and sworn statement of insanity. 

An abstract of the clinical history, giving home address and name 
and address of nearest relative, should always accompany the patient. 
Also a physician's sworn statement that the patient is insane and in 
need of treatment. 

6. (a) It is believed that many neuro-psychiatric patients have 
been discharged from the Army and Navy and are at large in the 
community. In view of the fact that neuro-psychiatric patients are 
liable to come in conflict with conventional customs of society it is 
thought that a certain percentage of these patients will sooner or 
later find their way before various civil police officials. Hence, police 
officials, jailers, wardens of prisons, and others concerned should 
be advised through the proper channels that the Public Health 
Service district supervisors have jurisdiction over the disposition of 
such beneficiaries of the Public Health Service. 



153 

(h) Officers of coiint}^ courts and other individuals who ordinarily 
have jurisdiction over neuro-psychiatric cases should be advised as 
to the proper disposition of such beneficiaries of the Public Health 
Service. (See in this relation paragraph 5, page 3.) 

O. SPECIAL EXAMINERS IN NEURO-PSTCHIATRY. 

1. (a) As noted above, the establishment of the special Public 
Health Service Hospitals requires a reasonable accuracy in diag- 
nosis before a patient can be sent to the proper hospital. 

(6) You should make the necessary arrangements with members 
of the medical profession specially trained in neuro-psychiatry, for 
the examination of such cases. In Appendix F you will find a list 
of physicians in your district who are rated to be able to diagnose 
mental and nervous afflictions. 

(c) It is believed that the district officers should investigate the 
physicians in this list as soon as oi)portunity is offered. If found to 
be suitable they should be recommended by the district officer to be 
designated by the Bureau of War Eisk Insurance as examiners, in 
accordance with the plan stated in bureau letter under date of July 
16, 1919. The discretion of the district officer will, of course, de- 
termine the most logical localities in which to designate neuro- 
psychiatric specialists as examiners. 

(d) The War Risk Insurance Bureau and the Bureau of Public 
Health Service should be advised as soon as these men are ap- 
pointed. 

2. (a) Appendix G is a list of mental clinics and out-patient de- 
partments in your district to which a mental case may be referred 
for examination. You should ascertain the activity of these out- 
patients departments and encourage institutions to establish them, 
so that the citizens of the State, including disabled discharged men, 
may secure advice. 

(&) A reasonable fee for examination of neuro-psychiatric claim- 
ants on the War Risk Insurance Bureau by these out-patients de- 
partments will be allowed. 

3. (a) Copies of the physicians' reports of examinations of claim- 
ants should be forwarded to the following: War Risk Insurance 
Bureau; Public Health Service Hospital to which patient is sent; 
district officer's file. 

(6) Date of examination, date of admission, and discharge from 
hospital should be stated. 

D. For your information there is included in Appendix H a 
copy of the " Program for Mental Hygiene, United States Public 
Health Service." 



154 

E, For your information, and action upon in suitable instances, 
there is included in Appendix I suggested standard forms of laws 
for the commitment, care, etc., of persons suffering from mental 
disorders. 

EespectfuUy, 

Rupert Blue, 
Surgeon General. 



Reconstruction Personnel. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ August i, 1919. 

Bureau Circular Letter No. 183. 

Medical officer in charge United States Marine and Public Health 

Service Hospital: 

A section of physical reconstruction has been established in the 
hospital division of the bureau to direct and supervise the several 
branches of physiotherapy and occupational therapy as measures for 
the functional restoration of the beneficiaries of the service. 

The personnel required for this work, consisting of reconstruction 
officers, head aides, and aides in physio and occupational therapy, 
together with the necessary equipment and supplies, will be sent to 
the several stations as circumstances may require. 

The pay and allowances of the aides wdll be the same as that now 
provided for the nurse corps of the service. 

In view of the above, it is requested that you furnish the bureau 
with information regarding the following persons who may be 
employed at your station at the present time, in order that their 
status may be determined : 

The names and duties of reconstruction aides or persons so acting 
engaged in any branch of physiotherapy or occupational therapy, 
including academic teaching or hospital social-service work, stating 
date of entry into service, rate of compensation, and whether 
quartered on the reservation or elsewhere. 

The names and duties of all Red Cross personnel attached to the 
station for whom quarters and subsistence are furnished under 
departmental authority dated July 5, 1919. 

A statement concerning all other activities, volunteer in character, 
embracing Red Cross, social service, library service, etc. 

Rupert Blue, 

Surgeon General. 



155 

Treatment of Beneficiaries of the Bureau of War Risk Insurance. 

Treasury Department, 
Bureau of Public Health Service, 

Washington, August 6, 1919, 

Bureau Circular Letter No. 184. 

To commissioned medical officers, acting assistant surgeons, customs 
officers, and others concerned^ 

1. A part of the act of Congress approved July 18, 1919, entitled 
"An act making appropriations for sundry civil expenses of the Gov- 
ernment for the fiscal year ending June 30, 1920, and for other pur- 
poses," which makes appropriation for the Bureau of War Risk 
Insurance, reads as follows : 

Provided, That none of appropriations made herein for the Bureau of War 
Risk Insurance sliall be expended to reimburse any expenses incurx-ed by any 
Government-owned hospital or hospital under contract with the Public Health 
Service for examination, care, or treatment of beneficiaries of the Bureau of 
War Risk Insurance. 

2. In accordance with the above quotation from this act, you are 
advised that, effective July 1, 1919, there will be no charge made by 
the Public Health Service for the examination, care, or treatment of 
beneficiaries of the Bureau of War Bisk Insurance at relief stations 
of the service. It will, therefore, not be necessary in future at 
second, third, and fourth class stations to render separate vouchers 
for the examination, care, or treatment of war-risk patients, as has 
been done heretofore in accordance with Bureau Circular Letter No. 
138, dated August 13, 1918; and at marine hospitals, the rendering of 
repayment accounts, Forms 1928 and 1929, should be discontinued, 
effective July 1, 1919. 

3. The above instructions mean that at second, third, and fourth 
class stations war-risk patients may now be included in the same 
voucher with American merchant seamen, but, as a matter of record, 
it is desired that the letters " W. R. L." be placed after the names of 
all war-risk patients on vouchers, relief certificates, hospital permits, 
and reports rendered on Form 8998. 

4. The expenses of examination by physicians selected by Public 
Health Service officers and designated by the War Risk Insurance 
Bureau, and hospital expenses while being examined, if at other than 
Government-owned or service contract hospitals, will be chargeable, 
until further notice, to the War Risk Insurance Bureau as heretofore. 

Respectfully, 

Rupert Blue, 

Surgeon General. 



156 

Treatment Discharged Canadian Soldiers. 

Tkeasuet Department, 
Bureau of Public Health Service, 

Washington, August 7, 1919. 

Bnrean Circular Letter No. 185. 

To eommissioned medical officers^ acting assistant surgeons, United 
States Public Health Service, and others concerned: 

1. You are advised that the Canadian Government has requested 
the Secretary of the Treasury to extend to discharged Canadian sol- 
diers resident in the United States the facilities of the hospitals 
of the Public Health Service. The Canadian Government is willing 
to provide similar facilities for discharged American soldiers in 
Canada. 

2. In compliance with this request the Secretary of the Treasury 
has authorized the admission of discharged Canadian soldiers to the 
hospitals of the service, and you are therefore directed to furnish 
them upon presentation of their discharge or copy thereof from the 
Canadian forces or other evidence which clearly establishes the 
claimants' identity and eligibility to examination and treatment, 
care and treatment when they apply for the same, at a per diem rate 
the same as is now charged for foreign seamen at first-class stations 
and contract rates at contract hospitals. 

3. A physical examination should be made of these discharged 
soldiers when they present themselves for such purpose and bills 
for necessary expenses for such examination or care and treatment 
should be rendered in the manner' prescribed by service regulations 
for the care of foreign seamen, except that such bills. Forms 1928 
and 1929, should be rendered to the bureau in duplicate for collec- 
tion and headed "Department of soldiers' civil reestablishment of 
Canada." The triplicate copy should be filed at the station. 

These bills, Forms 1928 and 1929, should include all charges for 
which the service is to be reimbursed, such as charges for care in 
hospital (both Government owned and contract) ; also any expense 
incurred for ambulance service, X-ray service, use of operating 
room, etc. 

4. In connection with such cases officers are informed that the 
Canadian Government undertakes to furnish necessary medical care 
for its discharged soldiers for any cause whatever for one year from 
date of discharge. 

5. All papers, such as vouchers, repayment accounts, Forms 1928 
and 1929, relief certificates, hospital permits, etc., should be sent to 
the Bureau of the Public Health Service. At first, second, and third- 



157 

class stations this class of patients should be entered in the record 
of hospital patients or record of out-patients, as the case may be, in 
the usual manner. At third-class stations such patients should be 
issued relief certificates, Form 1916, and hospital permits, Form 
1917, in the usual manner. Following the name of this class of 
patients in all papers, reports, vouchers, relief certificates, hospital 
permits, etc., should be placed " Discharged Canadian soldier," or 
this may be abbreviated " D. C. S." 

Examination, care, and treatment of discharged Canadian soldiers 
should also be furnished by the district supervisors. In fact, the 
foregoing instructions apply to district supervisors as well as to 
officers in charge of relief stations. 

District supervisors should be careful that cards A, B, C, and D, 
Forms 1971 A, 1971B, 1971C, and 1971D, and all other papers such as 
vouchers, reports on Form 8998, etc., covering this class of patients, 
should be marked " Discharged Canadian soldiers," or if writing 
space is limited, this may be abbreviated " D. C. S." 

Paragraph 2 above explains when to furnish examination, care, 
or treatment. 

Paragraph 3 above explains how payment accounts, Form 1928 
and 1929, should be rendered. 

Paragraph 5 above explains that such patients should be entered 
in the record of hospital patients or record of out-patients, as the 
case may be. Such patients should of course be given permit num- 
bers along with other patients in the usual manner. 

7. In rendering vouchers for the care of this class of patients at 
contract hospitals, and at hospitals selected by district supervisors, 
they may be included in vouchers for the care of American merchant 
seamen or War Eisk patients, but it is very important that the 
abbreviation "D. C. S." be placed after the name of each of such 
patients in these vouchers, and such vouchers should be accompanied 
by repayment accounts in duplicate. Forms 1928 or 1929, as the case 
may be, and a copy of the discharge from the Canadian forces, 
covering each of such patients. 

8. All charges for the examination, care, and treatment of this 
class of patients should be included in monthly report of relief fur- 
nished foreign seamen or other pay patients, Form 1927. 

Respectfully, 

Rupert Blue, 

Surgeon General. 



158 

Use of Cream and Substitutes for Butter. 

Tkeasury Department, 
Bureau of the Public Health Service, 

Washington, Septemher 25, 1919. 

Bureau Circular Letter No. 186. 

To commissioned medical officers, acting assistant surgeons, United 
States Public Health Service, and others concerned: 
As it is desirable to use cream for certain purposes in the hospitals 
of the service you are authorized to place this article in the future 
on subsistence proposals, and to issue it for the use of patients, nurses, 
and attendants in reasonable quantities where it is needed, keeping 
in mind that it is a costly commodity, and that as small a supply 
should be purchased as will meet the actual needs. 

Except for special cases where prescribed by a physician the cream 
should be diluted with milk in the proportion of 1 part of cream 
to 2 parts of milk. This is ordinary table 20 per cent cream. The 
double or 40 per cent cream should be diluted with milk in the pro- 
portion of 1 part of cream to 4 parts of milk. The dietitian, where 
one is in charge of the preparation of food, should oversee the serv- 
ing of cream and her requisitions for this article should be approved 
wherever possible, otherwise cream should not be used except for 
coffee, unless prescribed by a physician. 

The most satisfactory way of dispensing cream for coifee is by 
adding it before serving. When this procedure is followed a cer- 
tain amount of the coffee should be reserved without cream for those 
who prefer it black. It is wasteful to serve cream either in large 
or small containers on the table and the bureau does not desire its 
use in that way except in small messes where such methods may be 
economically adopted. The use of cream for cooking or in the 
manufacture of ice cream is, except in the most unusual cases, un- 
necessarily wasteful and, unless specifically prescribed in the prepa- 
ration of special diets, should not be used. If cream is diluted ac- 
cording to directions given above 1 ounce of the 20 per cent cream 
daily per capita is a fair allowance. 

There exists a prejudice against the table use of oleomargarine 
and as soon as patients become aware of the substitution they ex- 
press dissatisfaction and willfully waste more than they eat. It is 
therefore desired that the use of oleomargarine be discontinued and 
that a fair grade of butter be used on tables. Butter should be 
served in small butter plates and in squares cut by a butter-cutting 
machine, of which there are several desirable models on the market, 
one of the most satisfactory of which is that sold by the Food Ap- 
pliances Manufacturing Corporation of Rochester, N. Y. Hospitals 
of 100 beds or over should submit requisitions for such machines 



159 

in the usual way. For table service one piece of butter may be 
placed at each place and more may be served if requested. Under 
no conditions, in large messes, should butter be placed on the table 
in bulk. For cooking purposes oleomargarine possesses no advan- 
tage over lard, drippings, or the various lard substitutes, which 
latter are most desirable and economical for kitchen use. Butter 
should only be used in the preparation of food when specifically 
ordered for the sick by a physician. 

EespectfuUy, Rupert Blue, 

iSu7'geo7i Getieral. 



Transportation Requests. 

Treasukt Department, 
Bureau of the Public Health Service, 

Washington, August £9, 1919. 

Bnreaa Circnlar Letter No. 187. 

To district supervisors of United States Puhlic Health Service, medi- 
cal officers irC charge, and others concerned: 

The bureau desires that the greatest possible discretion be exer- 
cised in authorizing travel on Government requests for transporta- 
tion. Officers of the Public Health Service who have been em- 
powered to grant this privilege in connection with the treatment 
of beneficiaries of the Public Health Service should investigate with 
particular care each case under advisement and should weigh every 
consideration ottered by such cases before a decision is reached to 
allow transportation at the expense of the Government. 

The issuance of transportation requests should be under the im- 
mediate supervision of the officer signing these requests, and he 
should consider himself personally responsible for the justification 
of every request issued. 

EespectfuUy, Eupert Blue, 

Surgeon General. 



ITreatment of Disabled Men While Undergoing Training by the Federal Board 
for Vocational Education. 

Treasury Department, 
Bureau or Public Health Service, 

Washington, September 30, 1919. 

GBnrean Circnlar Letter No. 188. 

To commhsioned medical officers, acting assistant surgeons, and 

others concerned: 

1. You are advised that the Secretary of the Treasury has au- 
thorized the treatment in marine hospitals. Public Health Service 



160 

hospitals, contract hospitals, and relief stations of this service of dis- 
abled men discharged from the military forces who have entered 
upon and are undergoing a course for vocational training. Treat- 
ment in each instance is to be furnished upon the request (Form 
197 1-D) of the district officers of the Federal Board for Vocational 
Education, so far as facilities are available. 

2. After the district officers of the Federal Board for Vocational 
Education have ascertained, preferably by telephone, whether fa- 
cilities are available, they are authorized to use for this purpose 
the hospital admission card U. S. P. H. S., (Treasury Department, 
U. S. P. H. S. Form 19T1-D.) This card will be given to the man, 
who will be directed to present it to the designated hospital or relief 
station, and a copy will be sent immediately to the district supervisor 
of the Public Health Service. In using these cards it is understood 
that the Federal Board officers will strike out the words " For exam- 
ination only," will insert under " Class " the letters " F. B. V. E.," 
and will sign over their official title. 

3. A distinction should be made between war-risk beneficiaries and 
beneficiaries of the Federal Board for Vocational Education. Dis- 
charged men from the military forces who have entered upon and 
are undergoing a course for vocational training are entitled to treat- 
ment as beneficiaries of the War Risk Insurance Bureau for any 
injury or disease contracted prior to discharge, or for which they 
have previously received treatment while in the military service, 
or if the present disability can reasonably be connected with a 
former injury or disease incurred in the military service prior to 
discharge. 

4. Disabled men discharged from the military forces who have 
entered upon and are undergoing a course for vocational training, 
and who are in need of treatment for an injury or disease which is 
in no way connected with their military service, may receive such 
treatment at all relief stations of the Public Health Service at the 
expense of the Federal Board for Vocational Education, and sepa- 
rate vouchers headed " Federal Board for Vocational Education " 
should be rendered for the care of such patients through the Bureau 
of the Public Health Service for direct payment by the Federal 
Board for Vocational Educational Transportation, when necessary, 
to and from a hospital, for such cases will be furnished by the Fed- 
eral Board for Vocational Education. 

5. At stations of the first class (marine hospitals and Public 
Health Service- hospitals) a charge of $1.50 per diem for each patient 
shall be made, and repayment accounts. Forms 1928 or 1929, as the 
case may be, should be rendered the Bureau of the Public Health Serv- 
ice in duplicate. If expenditures are incurred for articles or services 



161 

under contract, such as X-ray or ambulance service, bills should be 
rendered on Form 1949, in favor of the payee, and transmitted 
through this bureau for direct payment by the Federal Board for 
Vocational Education. Such vouchers should be headed " Federal 
Board for Vocational Education." Charges covered by repayment 
accounts, Forms 1928 and 1929, should be taken up on the monthly 
report of relief furnished foreign seamen and other pay patients, 
Form 1927, but expenditures covered by vouchers forwarded for di- 
rect payment should not be taken up on Forms 1927 and 1955. 

6. At places where the service has a contract the per diem charge 
for each patient shall be the contract rate. Vouchers should be 
rendered on Forms 1926 and 1949, as the case may be, and headed 
" Federal Board for Vocational Education." They should be signed 
by the payee and certified by the medical officer in charge of the 
station, and must be accompanied by the original or copy of request 
for treatment in each case. Only one request is necessary, regard- 
less of the length of time a patient remains under treatment. 
Vouchers should be rendered promptly at the end of each month. 
Such vouchers should include not only charges for hospital care and 
treatment but miscellaneous services under contract, such as ambu- 
lance and X-ray service, use of operating room, etc. Expenditures 
covered by such vouchers should not be taken upon the monthly 
report of relief furnished foreign seamen and other pay patients. 
Form 1927, and monthly schedule of encumbrances. Form 1955. 

7. Where out-patients treatment is furnished repayment accounts, 
Form 1929, should be rendered to the bureau in duplicate covering 
such treatment at $1 per visit, and these items should be taken up 
on monthly report of relief furnished foreign seamen and other 
pay patients. Form 1927. 

8. Treatment of the above class of patients is to be made in each 
instance upon the written request, as provided in Paragraphs 1 and 2 
of the District Vocational Officer of the Federal Board for Voca- 
tional Education, so far as facilities are available. This applies to 
all relief stations of the Public Health Service. 

9. Differences of opinion between the Federal Board and the 
Public Health Service as to whether the board should bear the ex- 
pense of medical care in any particular case should be settled when- 
ever possible by conference between the District Vocational Officer or 
the District Medical Officer and the Direct Supervisor of the Public 
Health Service. 

10. When the man is about to be discharged from hospital the 
officer in charge will notify the District Vocational Officer and re- 
quest instructions as to his disposition. 

14330°— 21 11 



162 

11. A list of hospitals, relief stations, and other places where the 
service has a contract and a supply of Form 1971-D will be furnished 
by the District Supervisor on request. 
Respectfully, 

Rupert Blue, 

Surgeon General. 



Care of Motor Vehicles in Freezing Temperature. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ Septemher 30, 1910. 

Bureau Circular Letter No. 189. 

Medical oflcers in charge of hospitals of the United States Public 

Health Service, and others concerned: 

It is the duty of all personnel responsible for the care and upkeep 
of motor equipment to see that all necessary precautions are taken 
to prevent damage incident to the freezing of water in radiators, 
cylinders, and pumps of motor vehicles. Employees are earnestly 
requested to give these instructions particular attention. 

IN COLD weather WHEN MOTOR VEHICLES ARE NOT STORED IN HEATED 

BUILDINGS. 

{a) Radiators, pumps, cylinder blocks, and carburetors will be 
drained by opening the drain cocks at the lowest point in the circulat- 
ing system. 

( 5 ) The engine will be started and run slowly for one minute and 
the gas-line supply shut off at the tank, thus allowing the engine 
to " die," which will use up the remaining gasoline in the carburetor 
and line. Open sediment bulb under the tank for a few seconds also, 
to prevent water from freezing in it. 

(c) After the engine has stopped, the carburetor will be drained, 
as very often a few drops of water will have collected at the bottom. 
This procedure will effectively empty every drop of water from the 
engine and evaporate any remaining moisture around cylinders, 
pump, and radiator. 

{d) If the radiator is hot do not replace filler cap tightly, as the 
metal often contracts, making subsequent removal difficult. 

{e) In zero weather water will freeze in the cylinders even when 
the engine is running. Steps must therefore be taken to provide suit- 
able aprons of canvas or other material to cover the radiators. 

(/) Do not park vehicles for an extended time with hand brakes 
set. This practice often results in the bands freezing to brake drums. 



163 

(g) If radiator is frozen do not attempt to thaw it out by running 
the engine ; use hot water. 

ANTIFREEZING MIXTURES. 

There is only one antifreezing mixture that is suitable for use in 
the water-cooling system of a motor vehicle, and that is alcohol 
(denatured preferred). The per cent by volume to give a certain 
freezing point can be obtained from the table below : 



Freezing point ° F. 


Alcohol 

per cent 

by volume. 


Water 

per cent 

by volume. 


Specific 
gravity of 
mixture. 




20 
25 
30 
35 
40 
45 
50 


80 
75 
70 
65 
60 
55 
50 


0.975 




.969 




.964 




.959 




.953 


28 below zero 


.945 




.933 







Eespectfully, 



KuPERT Blue, 

/Surgeon General. 



Printing for Field Work of the Public Health Service. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, September 26, 1919. 

Bnreaa Circular Letter No. 190. 

To commissioned officers, and others concerned, United States Public 

Health Service: 

The legislative appropriation act approved March 1, 1919, con- 
tains the following provision : 

On and after July 1, 1919, all printing, binding, and blank-book work for Con- 
gress, the Executive Office, the judiciary, and every executive department, inde- 
pendent office, and establishment of the Government, shall be done at the Gov- 
ernment Printing Office, except such classes of work as shall be deemed by the 
Joint Committee on Printing to be urgent or necessary to have done elsewhere 
than in the District of Columbia for the exclusive use of any field service out- 
side of said District. 

In response to a request from this bureau, the Joint Committee on 
Printing has granted authority for printing to be done outside of the 
District of Columbia when deemed urgent or necessary for the use of 
this service, using in its authorization the following language : " For 
the immediate use of the Public Health Service, in its field work for 
relief and sanitation." 



164 

However, the committee coupled this authority with the following 
requirement : 

A detailed report of the classes, including number of copies, description, and 
cost, of the printing herein authorized shall be submitted to the Joint Com- 
mittee on Printing every three months, i. e., October 1, January 1, April 1, and 
July 1. 

In accordance with the foregoing, it is directed that no printing be 
done outside of the Government Printing Office unless the matter be 
one of pressing emergency, which will permit of no delay. It is fur- 
ther directed that the report above described be forwarded to the 
bureau at the close of each quarter, beginning October 1, 1919. 

Furthermore, whenever any emergency printing of the kind above 
described is ordered at a station, a letter should be immediately ad- 
dressed to the bureau making report of the action taken, and inclos- 
ing a copy of the material to be printed. 

Rupert Blue, 

Surgeon General. 



Compliance With Regulations Governing Publication in the Medical Journal 

Enjoined. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, Octoher 3, 1919. 

Bnrean Circular Letter No. 191. 

To commissioned officers, acting assistant surgeons, and fharmacists, 

United States Public Health Service : 

The attention of all officers is invited to paragraph 257 of the regu- 
lations, which reads as follows : 

A junior officer wishing to report the history of any case for publication in 
a medical journal shall obtain the consent of the officer in command. 

Strict compliance with this regulation is enjoined upon all officers. 
Furthermore, medical officers in charge of stations should weigh 
carefully the effect of implied service approval of conclusions pub- 
lished in articles by service officers, and if in doubt concerning the 
policy of the publication it should be referred to the bureau for 
approval. 

Bupert Blue, 

Surgeon General. 



165 

Reports of Relief for the United States Employees' Compensation 

Commission. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, October i, 1919. ■ 

Bnrean Circular Letter No. 192. 

To commissioned medical officers, acting assistant surgeons, and 
others concerned: 

1. Your attention is invited to the nature and purpose of the 
admission and discharge reports of cases treated under the pro- 
visions of the compensation act which you have been making to the 
United States Employees' Compensation Commission, in accordance 
with bureau circular letter No. 148, of December 27, 1918. 

2. The buff-card report. Form C. A. 20, is to be mailed to the 
commission as soon as a case comes under treatment. The white- 
card report. Form C. A, 21, is to be mailed when the case is dis- 
charged from treatment. 

3. These reports serve their purpose only when they are sent in 
promptly, the buff-card report when the case first comes under treat- 
ment, and the white card as soon as the case is discharged. Medical 
officers are, therefore, directed to see that these reports are not de- 
layed. If in any case it is impossible to forward the report promptly, 
it should be accompanied, when forwarded, by a letter of transmittal 
explaining the cause for the delay. 

Respectfully, 

Rupert Blue, 

Surgeon General. 



Instructions for Procuring Tires and Tubes for Motor Vehicles. 

Treasury Department, 
Bureau or Public Health Service, 

Washington, October 25, 1919. 

Bureau Circular Letter No. 193. 

7'o medical officers, and others concerned. United States Public 

Health Service: 

The bureau having made a contract with two tire companies to 
furnish all sizes of tires (pneumatic and solid) and tubes in all 
parts of the United States, it is directed that after November 15, 
1919, none of this equipment be purchased under department ap- 
proval of July 18, 1919, except in cases of emergency. 

All marine hospitals, United States Public Health Service hos- 
pitals, district headquarters, quarantine stations, and other places 



166 

where motor vehicles of this service are in use are directed to send 
their requisitions for tires and tubes to the Purvejdng Depot. A 
sufficient number of spare tires and tubes should be kept on hand 
to avoid emergency purchases, and requisitions should be forwarded 
at least two weeks before tires and tubes are needed in order to allow 
sufficient time for delivery. 

When making requisitions state size, type (clincher or straight 
side or quick detachable) and the make of the vehicle on which the 
tires and tubes are to be used. In all cases state clearly the address 
where the tires should be delivered. Upon receipt of same send the 
receipted invoice to the Purveying Depot as soon as goods are 
checked, noting shortage and defects, if any. 

If the stock of tires and tubes is carefully watched and sufficient 
time is allowed for delivery, it is believed that this method of 
procuring tires will prove satisfactory to the stations of the service, 
besides enabling the bureau to benefit by the prices quoted on a quan- 
tity contract. 

EespectfuUy, 

Rupert Blxtb, 

Burgeon General. 



Notation to be Made on Government Transportation Requests Before 
Presentation for Tickets. 

Treasury Department, 
Bttreatj of Public Health Service, 

Washington,, November 5, 1919. 

Bnreaa Circalar Letter No. 195. 

Medical officers and others using Government transforation requests: 
To expedite the auditing of railroad and Pullman car vouchers 
all persons using Government transportation requests are directed 
to place a notation on all requests presented for transportation or 
Pullman accommodations, showing the division of the bureau under 
whose direction the travel is performed. The following symbols 
should be used to indicate the different divisions of the bureau 
Personnel and Accounts, P. A.; marine hospital and relief, M. H. 
foreign and insular quarantine, F. Q. ; domestic quarantine, D. Q. 
venereal disease, V, D. ; scientific research, S. R. ; and sanitary re- 
ports and statistics, S. E.. & S. 

These notations should be placed on both original and memo- 
randum request under the official title of the person signing the 
request, 

Rupert Blue, 

burgeon General. 



167 

Transportation and Meal Requests — Instructions for Issuing Memorandum 

Copies. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, November 26, 1919. 

Burean Circular Letter No. 196. 

To medical o'/ficers and others concerned, United States Public Health 

Service : 

In order to expedite the work of auditing and rendering payment 
of bills incurred on transportation and meal requests issued by the 
service, it is directed that officers issuing and countersigning these 
requests, give careful attention to instructions governing same, and 
properly accomplish the forms before issuance. 

1. Knowing the exact purpose for which the request is issued the officer 
sliould state on the blank space at the lower right-hand corner of the Trans- 
portation form the reason for travel, briefly stating in the case of patients, for 
example, " Hospital to home," " For examination," " For hospitalization," etc. 

When the transportation request is issued to oflficers, and it is found imprac- 
tical to Gtate in advance the reason for travel, the officer to whom issued may 
state reason for travel by writing on the form when it is put to use, for exam- 
ple, " On inspection duty," " Changing station," " Joining station," "Attending 
conference," etc. 

The name of the traveler having been written in full, on the space provided 
(Name of traveler) on the form, the officer should at the same time fill out the 
space (Official title) at the lower right-hand corner, for example, "Attendant," 
" Patient," " Seaman," " Surgeon," etc. 

If left to the person traveling to supply the facts, it is invariably neglected, 
and the information can not be acquired without search and unnecessary cor- 
respondence. 

2. When more than one person is given transportation or meals on one re- 
quest, the name and title of each additional person should be plainly written 
on the reverse side of both original and memorandum copies. 

3. Place and date of furnishing should also be supplied by the issuing officer 
on space provided. This applies to transportation and meal requests alike. 

4. Forwarding memorandum copies of transportation and meal request should 
not be delayed beyond a reasonable period of time. The practice of allowing the 
copies to accumulate and forwarding them at weekly and monthly intervals ip 
erroneous and impedes the progress of accounting and the payment of vouchers. 
The need for the memorandum copies arises at the bureau soon after issuance 
and it becomes expedient to forward same forthwith. 

Compliance with these instructions is important in order to deter- 
mine to what appropriation the expenditure is chargeable. 
EespectfuUy, 

Bupert Blub, 

Surgeon General. 



168 

Report of Relief for the United States Employees' Compensation Commission. 

Treasury Department, 
Bureau of Public Health Service, 

Washington December 9, 1919. 

Burean Circular Letter No. 197. 

To corriTnissioned Tnedical officers, acting assistant surgeons, and 
others concerned: 

1. Referring to Bureau Circular Letters No. 148, dated December 
27, 1918, and No. 192, dated October 1, 1919, relative to rendering 
reports to the Employees' Compensation Commission covering cases 
of injured civil employees, you are advised that the commission re- 
ports under date of December 2, 1919, that many stations of the 
Public Health Service have not been forwarding these reports. 

You are therefore directed to comply with the two above-men- 
tioned circulars, and are again advised that the reports of admission. 
Form C. A.-20, and reports of discharge. Form G. A.-21, serves their 
purpose only when sent in promptly. 

2. You are also directed to number compensation cases serially, 
beginning a new series with No. 1 on January 1 of each year, the 
admission report, Form C. A.-20, and discharge report, C. A.-21, 
in any given case to have the same serial number. 

3. You are also directed to forward monthly, on the first of each 
month, to the Employees' Compensation Commission a statement 
covering the treatment of compensation cases during the preceding 
calendar month, showing — 

1. The total number of dispensary or out-patient treatments given 
to beneficiaries of the compensation act. 

2. The number of days' hospital treatment given to beneficiaries 
of the compensation act. 

Eespectfully, 

Rupert Blue, 

Surgeon General.^ 

Additions to Nomenclature of Diseases and Conditions. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, Decenvber 12, 1919. 

Bureau Circular Letter No. 198. 

The following additions are made to the Nomenclature of Dis- 
eases and Conditions contained in Miscellaneous Publication No. 16 
of the United States Public Health Service, to follow page 75 of that 
publication : 



169 

Diagnostic and prophylactic procedures. 



No. 



2112 
2113 
2114 
2115 
2116 
2117 
2118 
2119 
2120 
2121 
2122 
2123 
2124 
2125 

2126 



Procedure. 



Diphtheria, passive immunization against 

Diphtheria, test for susceptibility to ■. 

Diphtheria, toxin-antitoxin immunization against 

Pneumonia, immimization against 

Procedures not listed elsewhere 

Babies, immunization against 

SmalliK)x, vaccination against 

Syphilis, complement deviation test for 

Syphilis, cutaneous reaction for 

Tubercvilin reaction, cutaneous 

Tuberculin reaction, ophthalmic 

Tuberculin reaction, percutaneous 

Tuberculosis, complement deviation test for 

Typhoid fever, immunization against (including immunization 

against paratyphoid fever 

Venereal prophylactic treatment 



Class No.i 



xxvni 

XXVIII 

xxvni 

XXVIII 
XXVIII 
XXVIII 
XXVIII 
XXVIII 

xxvin 

XXVIII 

xxvin 

XXVIII 
XXVIII 

XXVIII 
XXVIII 



Internation- 
al classifica- 
tion. 



1 A new class is added to those given on p. 7 of Misc. Pub. 16, as follows: "XXVIII, Diagnostic and 
Prophylactic Procedures " 



Rupert Blue, 

Surgeon General. 



Treasury Department, 
Bureau of the Public Health Service, 

Washington^ DeceTuber 27^ 1919. 

Bnrean Circular Letter No. 199. 

(Supersedes Bureau Circular Letter No. 194.) 

Medical officers in charge and others concem£d: 

In order to make uniform the method of submitting personnel 
data pertaining to all classes of employees, except regular corps and 
reserve corps officers and acting assistant surgeons and consultants, 
furnished by the field offices of the United States Public Health 
Service, it is necessary to change the various methods now used by 
different stations and the following system will go into effect January 
1, 1920. 

attendants and other employees. 



Nominations, promotions, demotions, separations from the service, 
and all other changes in status will be forwarded to the bureau on 
" Personnel Form 3 " (sample of which is attached). This form will 
be forwarded in a general lot twice a month, four days before the 
pay rolls for that period are forwarded. In other words, if the 
pay roll is to be forwarded on the 15th of the month this form, cover- 
ing all changes up to and including the 11th, will be mailed on the 
11th. Forms covering all changes during the four days period before 
the rolls are forwarded will be attached to the pay roll when it is 
submitted. 



170 

As it is necessary that this information be in the bureau in order 
to intelligently audit pay rolls, all names appearing on the rolls for 
which no data has been received will be stricken off. If the amount 
shown after names on the pay rolls differs from the records in the 
bureau, the rolls will be passed according to the bureau's records. 

Oaths of office, letters stating that applicants will submit to vaccina- 
tion, and such information will be retained on file by the various sta- 
tions and not forwarded to the bureau. 

ACTING ASSISTANT SURGEONS AND CONSULTANTS. 

Nominations for acting assistant surgeons and consultants should 
be submitted in quadruplicate on the prescribed form (a copy of 
which is attached), one copy to be mailed directed to the Personnel 
and Accounts Division, U. S. P. H. Service, Washington, D. C. A 
supply of these forms can be obtained from the bureau upon request. 
This form will also be submitted for temporary acting assistant 
surgeons appointed pending commission in the reserve corps. 

A copy of the bureau's communication or other authorization must 
accompany the pay roll for all new names appearing thereon. If for 
any reason the status of a doctor changes during the pay-roll period 
all changes on the pay roll will be substantiated by a copy of com- 
munication affecting such change. Unless the order or communica- 
tion affecting such change is attached to the roll, the roll will be 
passed on the old basis. If this can not be done, the name will be 
stricken from the roll and a supplemental roll with the data affecting 
the change attached will have to be submitted. 

GENERAL INFORMATION. 

In quoting salaries of any employees 6f the service the base pay 
will be used. The base pay does not include the bonus. 

As some time must elapse before an intelligent estimate can be 
made of the ability and qualifications of an employee, the form 
recommending the bonus Personnel Form No. 2 (sample of which 
is attached) should not be written until the expiration of two weeks 
after entrance on duty. Those employees who are separated from 
the service within the two- week period will receive no bonus. 

Hereafter if employees are not certified for the bonus within one 
month from the date of entrance on duty, their certification there- 
after will begin from the time the letter is written. The department 
has shown a tendency to disapprove all old cases where men have 
not been certified for the bonus until several months had elapsed. 

Stations will submit each month to the Division of Personnel and 
Accounts U. S. P. H. Service, Washington, D. C, a list of the doctors 



171 

on duty there during the month, and any changes which have taken 
place since last report, on Personnel Form No. 1 (sample of which 
is attached) showing their principal duties, such as treating war- 
risk insurance beneficiaries, consultants in surgery, quarantine, immi- 
gration, or special assignments. 

EuPERT Blue, 

Surgeon General. 



status of doctors. 
Personnel form No. 1. 



United States Public Health Service. 



Station 
Date . . . 



Name. 


Designation. 


Salary. 


Duties. 


John Johnson 


P. A. surgeon 




In charge of hospital. 


Henry Smith 


Asst. surgeon 




Executive officer. 


John Roe 


Asst. surgeon 




Tuberculosis work. 


Richard Brown 


A. A. surgeon. . 


82,500 
2,400 

2,500 

960 

2,400 


Head and throat work- 




A. A. surgeon 


Mental diseases. Transferred from Green- 


Allen Lambert 


A. A. dent, surgeon . . . 
Consultant 


ville, S. C. Reported 12-15-19. 
Dental examinations. Reported 12-20-19 




Surgery. 


Harvey Robertson 




Resigned 12-15-19. 







In charge. 



INSTRUCTIONS. 



This form will be mailed on the last day of each month to the bureau, one in 
a separate envelope addressed to the Surgeon General, U. S. Public Health 
Service, Personnel and Accounts Division, Washington, D, C, and one in an 
envelope addressed to the Marine Hospital Division, TJ, S. Public Health Service, 
Washington, D. C. 

The ent:ries on this form may be according to relative rank or otherwise, as 
the station desires, but the designations will be placed last. Salary to be quoted 
on A. A. surgeons and consultants. 

If a consultant is on duty at the district office as well as at a hospital, his 
name will be shown in both places. 



United States Public Health Seevicb. 



Bonus certifications. 
Persoimel form No. 2. 



Station 
Date.... 



The ability and qualification of the following employees justify the increased compensation: 



Name. 



Designation. 



Salary per 
annum. 



Date of en- 
trance on 
duty. 



John Johnson. . 
Henry Smith... 
Richard Brown 

John Roe 

Patrick Green. . 



A. A. surgeon 
A. A. surgeon 
A. A. surgeon 
Stenographer . 
Attendant . . . 



$2,400 

2,000 

1,800 

1,200 

600 



Dec. 15, 1919 
Dec. 20, 1919 
Dec. 15, 1919 
Dec. 5, 1919 
Dec. 20, 1919 



In charge. 



172 



INSTBTJCTIONS FOR USE OF THIS FOBM. 

Ttiis form will be made up in triplicate, one copy to be retained on file at 
the station and the other two to be mailed to the Surgeon General, Washing- 
ton, D. C. 

Attention is invited to Bureau Circular No. 176, a copy of which is attached. 
The name of an employee will not appear on this form for certification for 
the bonus until he has been on duty at least two weeks. 

If any employee's name appears on this form who has been on duty more 
than one month and entitled to the bonus, the reason for the delay in certifying 
him will be explained in the last column. 



Changes in personnel. 
Personnel form No. 3. 



United States Public Health Service. 



Station 
Date . . . 



Name. 


Designation. 


Date 
effective. 


Base alary. 


Vice promotions, demotions, dis- 
continuance, and remarks. 


Doe, John 


Attendant 

Act. cook 

Clerk 


11- 5-19 
11- 8-19 
11-10-19 
11-11-19 
11-15-19 
11-1&-19 


$450 P. A 


John Smith resigned 11-4-19. 


Irving, Henry 


J500 P. A 


Wm. Black resigned 11-5-19. 


Johnson, Robt . . . 


J840 P. A . . 


New position. 


Lamont, Preston. . . 
Smith, George 


Stenograpl'er.. 
Tel. operator.. 
Chauffeur 


$1,000 P. A 

$600 P. A.. .. 


Promoted from $900 P. A. 
Demoted from $720 P. A 


Brown, Richard 


$840 P. A 


Discharged for inefficiency. 









In charge. 



INSTBTJCTIONS FOB THE USE OP THIS FOBM. 



Changes should be recorded on this form as they happen. In other words, 
enter the changes each day and when the time arrives for forwarding to the 
bureau it will be complete and require only checking. 

If an employee is furnished quarters, subsistence, and laundry, it will be 
noted in last column. 

One copy of this form will be mailed direct to the Personnel and Accounts 
Division and two copies to the Marine Hospital Division, Washington, D. O. 



Countersigning Transportation and Meal Requests in Bona Fide Handwriting. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ January 20^ 1920. 

Bnrean Circular Letter Na. 209. 

To medical officers and others concerned, United States Public Health 

Service : 

It has come to the attention of the bureau that a number of officers 
have permitted the use of a rubber stamp facsimile of their signature 
in countersigning transportation and meal requests, which is con- 



173 

trary to instructions and a violation of department regulations 
governing the issuance of these Government forms. 

Department Circular No. 49, OiSce of the Comptroller of the Treas- 
ury, dated June 19, 1915, paragraph 4, on the subject of transporta- 
tion requests, is as follows : 

The original request sliould bear tlie signature of the head of department 
or other proper authorizing officer, either in writing or facsimile thereof. It 
must further be countersigned by the issuing officer in his own bona fide hand- 
writing at the time of issue to the traveler, and will not be recognized as valid 
by the transportation companies unless so countersigned. Any failure or neglect 
on the part of either Government officials or the transportation companies to 
comply with these requirements may subject claims for payment for transpor- 
tation services to delay and possible rejection by the accounting officers of 
the Treasury. 

Officers who in the performance of duty are authorized to issue 
transportation and meal requests can not delegate others to perform 
this act of countersigning same in their name, nor should they direct 
employees to use a facsimile, it being prohibited. 

In order to meet this situation medical officers in charge, district 
supervisors, and officers now performing this administrative duty, 
or who may hereafter be designated, may, when it becomes necessary 
by the stress of duties, recommend to the Surgeon General for his 
approval the name of such executive, principal, or chief clerk under 
his charge who will be designated and authorized to countersign 
transportation and meal requests, by direction of the Surgeon Gen- 
eral, under the same regulations as now apply, and under such condi- 
tions and rules as may be prescribed by the United States Public 
Health Service Regulations. 

Respectfully, Rupert Blue, 

Surgeon General. 

Treatment of Discharged Canadian Soldiers — Amendment to Bureau Circular 

Letter No. 185. 

Treasury Department, 
Bureau or Public Health Service, 

Washington, January 15, 1920. 

Bureau Circalar Letter No. 201. 

To commissioned medicial officers, acting assistant surgeons, U. S. 

Public Health /Service, and others concerned : 

1. The following is an extract of a letter received by the Chief 
Medical Adviser, Bureau of War Risk Insurance, from the Director 
of Medical Services, Department of Soldiers' Civil Reestablishment, 
Ottawa, Canada : 

1. A recent amended order in council, P. C. 387, passed February 24, 1919. 
By this amendment exmembers of the C. E. F., to obtain the benefits of treatment 



174 

for any condition for one year following discharge from the Army, must be resi- 
dent in Canada. 

In view of the above, paragTapli 4, of Bureau Circular Letter No. 
185, dated August 7, 1919, is hereby annulled. 

2. The following- is an extract from a letter dated November 10, 
1919, to the Chief Medical Adviser, Bureau of War Risk Insurance, 
from the Director of Medical'Services, Department of Soldiers' Civil 
Reestablishment, Ottawa, Canada: 

2. On application for treatment by an exmember of the British or Canadian 
forces, who is suffering from a disability due to or aggravated by service, it is 
requested that two copies of S. C. R. 346 be forwarded to the Director of Medi- 
cal Services, Soldiers' Civil Reestablishment, Ottawa. It is suggested tliat 
where institutional treatment is recommended, this form be forwarded, after 
admission to such institution, in order that sections thereof, asking for date 
of admission to hospital and other information necessary in order that pay and 
allowances may be granted, may be filled out. 

It is desired that this procedure be followed in all cases except those of 
venereal disease, it being understood that such cases are not to be treated 
as on the strength of this department, except where the disability is one of 
tertiary syphilis or complications thereof. 

In view of the fact that S. C. R. regulations with regard to the treatment of 
venei-eal-disease cases of this nature, involve the closest scrutiny of medical 
documents, it would seem desirable that, where such cases present themselves 
to your representatives for treatment, such treatment should not be given until 
the case has been referred to this department. 

On completion of treatment of exmembers of the British or Canadian forces 
resident in the United States, or when such cases have been considered to have 
reached a stage of finality, it is desired that S. O. R. Form 76 should be com- 
pleted and two copies forwarded to the Director of Medical Services, Soldiers' 
Civil Reestablishment, Ottawa. 

In furnishing relief to dischareed British or Canadian soldiers, 
you are directed to comply with the above requests and instructions. 
Respectfully, 

Rupert Blue, 
Surgeon General. 



Treasury Department, 
Bureau or the Public Health Service, 

Washington^ January 23, 1920. 

Burean Circular Letter No. 202. 

To commissioned medical officers, acting assistant surgeons, and 

others concerned: 

There is attached hereto an addendum to Miscellaneous Publica- 
tion No. 16, 1916, being a nomenclature or classification of mental 
diseases. This classification corresponds to that adopted by the 
American Medico-Psychological Association May 30, 1917. New 
numbers (2500 to 2553) have been introduced for terms not appear- 
ing in the original Miscellaneous Publication No. 16. 



175 

You are requested to utilize the numbers in the left-hand column 
of the addendum in lieu of the diagnoses made in accordance with 
the above-mentioned Miscellaneous Publication No. 16. 
EespectfuUy, 

Rupert Blue, 
Surgeon General. 

Addendum to Miscbllankous Publication No. 16, 1916. 
'Nomenclature of diseases and conditions — Classification of mental diseases. 



Disease. 



Classification 
of American 
Medico Psy- 
chological 
Association. 



Psychoses, Tbaumatic 

Traumatic delirium 

Traumatic constitution 

Post-traumatic mental enfeeblement 

Psychoses, Senile 

Simple deterioration 

Presbyoptirenic type 

Delirious and confused states 

Depressed and agitated states in addition to deterioration. 

Paranoid states 

Presenile types 

Psychoses with Cerebraii Arteriosclerosis 

General Paralysis 

Tabetic type 

Cerebral type 

Psychoses with Cerebral Syphilis 

Psychoses with Huntington's Chorea 

Psychoses with Brain Tumor 

Psychoses WITH Other Brain or Nervous Diseases 

Cerebral embolism 

Paralysis agitans 

Meningitis, tubercular or other forms 

Mutiple sclerosis 

Tabes. 



4cute chorea 

Psychoses Intoxication 

Pathological intoxication^ 

Delirium tremensi 

Korsakow psychosesi 

Acute hallucinosisi 

Chronic hallucinosis^ 

Acute paranoid type' 

Chronic paranoid type^. 

Alcoholic deterioration! 

Other tjnpes, acute or chronic' 

Opium (and derivatives), cocaine, bromides, etc., alone or combined (to be 
specified l^ 

Metals, as lead, arsenic, etc. (to be specified)^ 

Gases (to be specified )2 

other exogenous toxins (to be specified) 2 

Psychoses with Pellagra 

Psychoses with other Somatic Diseases 

Delirium with infectious diseases (specify) 

Post-infectious psychosis 

Exhaustion delirium 

Delirium of unknown origin 

Cardio-renal diseases 

Diseases of the ductless elands 

other diseases or conditions (to be specified) 

Manic-Depressive Psychoses 

Manic type 

Depressive type 

Stupor 

Mixed type , 

Circular type 

Involution Melancholia , 

Dementia Precox (simple type) , 

Paranoid type 

Catatonic type 

Hebephrenic type 



1 Alcoholic. 

* Drugs and other exogenuous toxins. 



1 

1(a) 

Kb) 

1(c) 

2 

2 (a) 

2(b) 

2(c) 

2(d) 

2(e) 

2(f) 

3 

4 

4(a) 

4(b) 

5 



9 


9(a) 


9(b) 


9 (c) 


9(d) 


9(e) 


9(f) 


9(g) 


9(h) 


9(i) 


10 (a) 


10(b) 


10(c) 


10(d) 


11 


12 


12 (a) 


12(b) 


12(c) 


12(d) 


12(e) 


12(f) 


12(g) 


13 


13 (a) 


13(b) 


13(c) 


13(d) 


13(e) 


14 


15,15 (d) 


15 (a) 


15(b) 
15 e) 



176 

Nomenclature of diseases and conditions — Classification of mental diseases- 

Continued. 



No. 



920 

921 

1008 

2545 

2546 

2647 

1010 

1006 

845 

2548 

2549 

2550 

648 

382 

1377 

2551 

2552 

2553 

631 

632 



Disease. 



Paranoia 

Paranoid State 

Psychoses, Epileptic 

Deterioration 

Clouded states 

Other conditions 

Psychoses, Hysterical 

psychasthenia 

Neurasthenia 

Anxiety Neuroses 

Psychoses WITH Constitutional Psychopathic Inferiority 

Psychoses "with Mental Deficiency 

Undiagnosed Psychoses 

Epilepsy without Psychosis 

Alcoholism without Psychosis 

Druq Addiction without Psychosis 

Constitutional Psychopathic Inferiority without Psychosis. 
Mental Deficiency without Psychosis 



Idiocy. 
Imbecility. 



Classification 
of American 
Medico Psy- 
chological 
Association. 



16 
16 
17 

17 (a) 
17(b) 

17 (c) 

18 (a) 
18(b) 
18(c) 
18(d) 
19 

20 
21 

22 (a) 
22 (b) 
22 (c) 
22 (d) 
22 (e) 



Confidential Efficiency Report. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ February 8, 1920. 

Bureau Circular Letter No. 203. 

To all commissio7ied officers., acting assistant surgeons., pharmacists^ 
and others concerned: 

The inclosed form (1962-a) will supersede Form 1962, "Informa- 
tion required of officers in charge, Public Health Service, concerning 
officers on duty at their respective stations." 

Instructions are printed on the form and should be followed 
closely. Attention is directed especially to the time such reports are 
to be submitted, and to the procedure to be followed when an un- 
favorable entry of fact is made. 

These reports will be used by promotion boards to a large extent 
as a basis for their recommendations. 

The care and thoroughness with which reports are rendered will 
be considered in forming an estimate of the reporting officers' ability 
to judge men and their qualifications for administrative duty. 

Officers in charge should render these reports in their own hand- 
writing and send them to the surgeon general's office in an envelope 
plainly marked "Division Personnel and Accounts." They will be 
kept on file in the office of the chief of that division and will be used 
or inspected only under his immediate supervision. 

A report on this form should be submitted in case of all commis- 
sioned officers, acting assistant surgeons, pharmacists, and other ad- 



177 

ministrative or technical personnel below the grade of senior surgeon, 
exclusive of nurses and what have been ordinarily known as at- 
tendants. 

J. C. Perry, 
Acting Surgeon General. 



Countersigning of Transportation Requests — Amendment to Bureau Circular 

Letter No. 200. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington,, Fehruary 19, 1920. 

Bnrean Circular Letter No. 204. 

To commissioned officers and others concerned, United States Public 

Health Service: 

The last two paragraphs of Bureau Circular Letter No. 200, Jan- 
uary 20, 1920, are changed to read as follows : 

Officers in charge are authorized to designate any commissioned officer at 
their stations to countersign transportation requests. It is believed that a 
sufficient number of commissioned officer are assigned at all stations of the 
service to perform this duty. If, under exceptional circumstances, it is desired 
to delegate this function to an executive clerk or other employee, proper recom- 
mendation should be made to the surgeon general for his approval designating 
the employee by name, and stating in full the reasons for the request. 
Respectfully, 

J. C. Perry, 
Acting Surgeon General. 



Instructions for Discontinuing Bonus Part-Time Employees. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, March 6, 19£0. 

Burean Circular Letter No. 205. 

To medical officers in charge of United States marine and United 
States Public Health Service hospitals, district supervisors, and 
others concerned: 

Due to a recent ruling by the honorable the Secretary of the Treas- 
ury in accordance with the act of March 1, 1919, bonus will not be 
allowed to part-time employees including acting assistant surgeons 
and attending specialists (consultants) except in the case of "char- 
women " and you are hereby directed to discontinue the bonus in 
each case in accordance with the above ruling, effective March 1, 
1920. 

14330°— 21 12 



178 

In the event that the amount of work performed by part-time 
employees warrants an increase in base pay to equal the original 
base pay plus bonus, you are informed that a recommendation to this 
effect will be considered by the bureau. 

All recommendations for change in salary at the hospital or sta- 
tion under your charge, due to the above ruling, should be included 
in the one communication, in order to simplify the necessary read- 
justment. 

Respectfully, 

J, C. Perry, 
Acting Surgeon Qenerdl. 



Method of Procuring Spare Parts, Accessories, and Repairs for Motor 

Transportation. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ March ^, 1920. 

Bureau Circular Letter No. 206. 

To medical o'fficers of the United States Public Health Service: 

You are advised that bureau similar letter of August 1, 1919, is 
hereby amended. 

Paragraph 1. The Motor Transport Corps, United States Army, 
no longer furnishes accessories, spart parts, and repairs for vehicles 
of this service. 

Paragraph 2. The purchase of accessories, spare parts, and repairs 
in the open market without first obtaining bureau authority is dis- 
continued, with the following exceptions: 

In an emergency, tires and tubes, spark plugs, skid chains, and 
light bulbs may be purchased without bureau authority. 

Spare parts maye be purchased in the open market, when necessary 
for immediate repairs, without bureau authority if they may be pro- 
cured locally; otherwise spare parts may be procured through the 
Purveying Depot and in no case shall any station order parts from 
the factory manufacturing the vehicle. In cases where parts can 
only be obtained from the factory, delivery will be expedited and a 
more favorable price obtained when ordered through the Purveying 
Depot. 

All requisitions for replacement parts to be carried in stock at 
stations will be forwarded to the Purveying Depot for approval. 

Repairs not exceeding $25 on motor vehicles owned by this service 
may be made without bureau authority when it is not practicable 
to do the work at the station. When extensive overhauling is necessary 



179 

and the work can not be performed at the station, a list showing the 
extent of rej)airs and replacements with estimated cost thereof shall 
be forwarded to the Purveying Depot for approval. 

It is not desired to make any changes in the present method of 
purchasing gasoline and repairing tires and tubes. 

This autliority should not be considered as a cancellation of the 
approval of contracts made with dealers. 

Department approval of July 18, 1919, should be cited on bills as 
authority for all expenditures made in accordance with the foregoing 
instructions. 

Eespectfully, 

J. C. Perrt, 
Acting Surgeon General. 



Treasttrt Departmeistt, 
Bureau of the Public Health Service, 

Washington^ March 12, 1920. 

Bureau Circular Letter No. 207. 

To commissioned medical officers, reserve officers, acting assistant 
surgeons, United States Public Health Service, and others con- 
cerned: 

The bureau desires to correlate the activities of the personnel of 
the several divisions of the Public Health Service, as they relate 
to the venereal infections of the general public, and particularly of 
beneficiaries of the service and discharged soldiers, sailors, and their 
families. 

Every person suffering from venereal disease coming to the atten- 
tion of an officer of this service should be given advice relative to 
his infection. He should be advised of the provisions that have been 
made for the prevention of the spread of venereal diseases. In case 
such person is not entitled to treatment as a beneficiary of the 
service he should be referred to the nearest venereal disease clinic 
listed in Reprint No. 521. He should be instructed to communicate 
with the venereal disease-control officer of his State board of health, 
or the United States Public Health Service, 228 First street NW. 
Washington, D. C, if additional advice or assistance is required. 

If additional information is desired relative to venereal disease- 
control activities, specific questions concerning which instructions 
are desired should be addressed to the bureau. 

H. S. Gumming, 
Surgeon General, 



180 

Interpretation of Bureau Circular Letter No. 201. 

Treasury Department, 
Bureau of Public Health Service, 

Washington, March 22, 1920. 

Bureau Circular Letter No. 208. 

To commissioned medical ofjlcers, acting assistant surgeons, Public 

Health Service, and others concerned: 

Bureau Circular Letter No. 201, dated January 15, 1920, amending 
Bureau Circular Letter No. 185, relative to the treatment of dis- 
charged Canadian soldiers, has in many instances been misconstrued 
by officers and others concerned in the field. 

The following interpretation by the foreign relations section. 
Bureau of War Risk Insurance, of Bureau Circular Letter No. 201, is 
as follows: 

The quotation in paragraph 1 means that a discharged Canadian 
soldier living within the Dominion of Canada can receive treatment 
(by his own Government) for any disability whatsoever, whether 
of service origin or not, during the first 12 months following his dis- 
charge. 

If the discharged soldier lives outside the Dominion of Canada, 
he can only receive treatment for disabilities contracted in the service 
or aggravated by the service, and for such disability he is entitled 
to treatment at any time whether before or after the expiration of 
one year from date of discharge, and such treatment should be fur- 
nish'ed by officers of the Public Health Service. 

In this connection, you are also informed that SCR Forms 76 and 
346, when executed by examiners in the case of discharged British 
or Canadian soldiers, should in each case be forwarded to the dis- 
trict supervisor, who shall prepare three additional copies, one to be 
retained by him and the other three copies to be forwarded to the 
Director of Medical Services, Department of Soldiers' Civil Re- 
establishment, Ottawa, Canada, through the Chief Medical Advisor, 
Bureau of War-Risk Insurance, Foreign Relations Section, Canadian 
Unit. That bureau will retain one copy and forward two copies to 
Ottawa, Canada. 

H. S. CuMMING, 

Surgeon General. 



181 

Instructions Concerning Signature of Officers in the Reserve. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, March 29, 1920. 

Bureau Circular Letter No. 209. 

To cotnTnissioned officers and pharmacists, United States Public 

Health Service: 

Bureau Circular Letter No. 164 (May 5, 1919) is hereby amended 
to read as follows : 

Hereafter all official matter to be signed by reserve officers on active duty in 
the reserve corps shall be prepared for signature with their reserve title im- 
mediately followed by the word " Reserve " in parentheses. All correspondence 
addrespf-^i. to such officers shall have the word " Reserve " in parentheses im- 
mediately following their title. 

In official correspondence with the bureau concerning pay rolls, 
travel orders, etc., officers on inactive duty in the reserve, but on 
active duty in some other capacity, should not make use of their 
reserve titles. 

Note. — The purpose of this letter is to obviate the necessity of 
explaining to the department in each case when an order requiring 
the expenditure of money is addressed to an individual who is com- 
missioned in the reserve, but is serving under a different designation. 

H. S. Gumming, 
Surgeon General. 

Advantages of Joining the Association of Military Surgeons of the 

United States. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, March %5, 1920. 

Bureau Circular Letter No. 210. 

To commissioned medical officers of the Public Health Service: 

It is desired to point out that officers of the Public Health Serv- 
ice are eligible for membership in the Association of Military Sur- 
geons of the United States. This association was incorporated by 
act of Congress and receives the official support of the Surgeon Gen- 
erals of the Army, Navy, and Public Health Service, and Chief, 
Bureaus of Militia Affairs of the Army and Navy. 
The constitution provides as follows : 

The officers shall be a president and three vice presidents, who shall be 
elected from and represent in regular rotation the Army, the Navy, the Public 
Health Service, and the Organized Militia ; a secretary and a treasurer ; all of 
which officers shall hold their respective offices until their successors are elected 
and qualified. 



182 

It stands for medico-military education, progress, coordination, 
and betterment of the services. Its meetings furnish opportunities 
for discussion of important medical and sanitary questions. The 
magazine is a high-class periodical and contains a number of valuable 
and interesting articles. 

At present the number of Public Health Service officers holding 
membership in this association is relatively small, and it is desired to 
increase this number as much as possible. It is believed that if 
officers will give careful consideration to the advantages of mem- 
bership in this association that the number of representatives of this 
service will be materially increased. 
Respectfully, 

H. S. Gumming, 
Surgeon GeneToH. 



Granting of Commissary Privileges to Officers of the Public Health Service. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, March 25, 1920. 

Bureau Circular Letter No. 211. 

To officers of the Public Health Service: 
A deficiency act approved March 6, 1920, provides as follows: 

Hereafter officers of the Public Health Service may purchase quartermaster 
supplies from the Army, Navy, and Marine Corps at the same prices as charged 
officers of the Army, Navy, and Marine Corps. 

This provision extends the commissary privileges to officers of the 
Public Health Service, and it is believed that the different stations 
where supplies are sold have been notified of this authority. 
Eespectfully, 

H. S. Gumming, 
Surgeon General. 

Exhibits and Ideas to Illustrate the Several Activities of the United States 
Public Health Service, Giving Emphasis to the Rehabilitation of Disabled 
Soldiers. 

Treasury Department, 

Bureau of the Public Health Service, 

Washington, March 31, 1920. 

Bureau Circular Letter No. 212. 

To medical officers in charge, U. S. Puhlic Health Service hospitals, 

and others concerned : 

You are advised that the bureau desires to obtain at once exhibits 
and ideas for exhibits illustrating the several activities of the service 
for possible future use in this country and abroad. 



183 

These exhibits should present concisely the work of the several 
divisions, special emphasis being given to the rehabilitation of the 
disabled soldier, including the methods for the relief and aftercare of 
cases of bone and joint deformities, of amputation cases and those 
otherwise maimed, of the blind and deaf, of neuro-psychiatric, tu- 
bercular, and cardiovascular cases, of those suffering from neuroses 
or from the after-effects of poisonous gases, of maxillo- facial cases, 
and of patients with constitutional or other diseases. 
The exhibits may be — 

(a) Charts showing the general scope of present activities and 

future plans. 
(6) Maps, photographs, and posters. 

(c) Methods of application and products of occupational 

therapy. 

(d) Models illustrating all types of work. 

(e) Case reports of special interest, with complete history, draw- 

ings, series of photographs showing progress, casts, ap- 
paratus, etc. 
(/) Plans of hospitals, and models of hospitals to scale 
(iV inch to 1 foot). Such models should include the reser- 
vation if possible. 
You are directed to give this matter publicity at your station mak- 
ing every effort to enlist the enthusiastic cooperation of both person- 
nel and patients, and to receive and forward to the bureau, attention 
officer in charge of service exhibit, all plans and suggestions sub- 
mitted.^ 

Each article prepared will be marked with description named, date 
of preparation, name of person making same, and the name and num- 
ber of the hospital, and will be held for further instructions, a de- 
scription of the article being forwarded to the bureau at once. 

H. S. Gumming, 
Surgeon General. 

Credit Allowed for Service in Army, Navy, Marine Corps, and Coast Guard 
in Computing Longevity Pay. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, April 5, 1920. 

Bnrean Circular Lrctter No. 213. 

To officers of the Public Health Service: 

Attention is called to the following provision, quoted from the 
deficiency appropriation act approved March 6, 1920 : 

Officers of the Public Health Service shall be credited with service in the 
Army, Navy, Marine Corps, and the Coast Guard in computing longevity pay. 



184 

An officer who is entitled to longevity increase in pay under the 
above provision should file with the first pay roll on which he claims 
such longevity pay a statement showing his service in each of the 
branches, such statement to be supported by a certified service record 
or records. The statement should show the date of enlistment or of 
commission and the date of termination of each period of service, 
together with the time of service under each enlistment or commis- 
sion and the total time of service under all enlistments and commis- 
sions, such total to include service in the Public Health Service. 

Certified service records to support the statement may be obtained 
from the proper officers, as follows: 

The Adjutant General of the Army. 
Chief, Bureau of Navigation, Navy Department. 
Adjutant and Inspector of the Marine Corps. 
Commandant of the Coast Guard. 
Subsequent pay rolls will simply show that he has completed 5, 10, 
15, or 20 years' service, as the case may be. 

Service in the National Guard while in the service of the United 
States may be counted in computing longevity pay, but service in the 
National Guard while not in the service of the United States can 
not be so counted. 
Respectfully, 

H, S. CuMMING, 

Surgeon General. 

Third and Fourth Class Stations Under the Direct Supervision of District 

Supervisors. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, April 12, 1920. 

Bureau Circular Letter No. 214. 

To medical officers of the Public Health Service, deputy collector of 

customs, and others concerned: 

It is directed that, effective May 1, 1920, Public Health Service 
relief stations of the third and fourth class shall be under the direct 
supervision of district supervisors, and all correspondence, reports, 
proposals, requisitions, vouchers, etc., shall be forwarded to the 
bureau through the district supervisor who has charge of the district 
in which the relief station is located. 

Reports and vouchers shall be made up at the relief station and 
marked O. K. and initialed by the medical officer or deputy collector 

in charge, as per example y^^' , and when received by the district 

supervisor should be certified by him and forwarded to the Bureau 
of the Public Health Service. 



185 

Third and fourth class stations that in the past have rendered 
monthly schedules of incumbrances, Form 1955, will continue to do 
so, but forward same through the district supervisor for his cer- 
tification. 

Respectfully, 

H. S. Gumming, 
burgeon General. 

Discontinuance of Motor Vehicle Reports and Instructions for Ordering 

Spare Parts. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, April ^4, 1920. 

Bureau Circular Letter No. 215. 

To medical officers of the United States Public Health Service, and 
others concerned : 

1. The monthly inventory of motor vehicles required by unnum- 
bered bureau circular letter of July 21, 1919, is hereby discontinued. 

2. In ordering spare parts for motor vehicles, the instructions in 
the catalogue should be followed and the motor and chassis numbers 
of the vehicles for which parts are required and the exact name and 
part number should be given, as listed in the catalogue. 

3. The Public Health Service has no Dodge cars for issue. 

H. S. Gumming, 
Surgeon General. 

Relative Treatment Furnished Discharged SoMiers of the Allied Nations. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, Api-ll 26, 1920, 

Bureau Circular Letter No. 216. 

To medical officers of the United States Public Health Service, and 

others concerned: 

The following letter dated April 17, 1920, has been received from 
the Ghief Medical Advisor, Bureau of War Hisk Insurance : 

The bureau is daily leceiving a large number of accounts against the depart- 
ment of Soldiers' Civil Reestablishment, Ottawa, returned, payments being dis- 
allowed because of the fact that the disability for which the expense had been 
incurred was not of service origin or had not been aggravated by military serv- 
ice; in many cases because the disease was an acute process contracted after 
discharge from the service, and having no possible connection therewith, or 
because the disability was of venereal origin. 

It is requested that the Surgeon General call the attention of district super- 
visors to the fact tiiat no discharged disabled member of the military or naval 



186 

forces of any of the allied or associated powers should be taken for treatment 
except for disabilities of service origin or which have been aggravated by his 
military service. 

Especial attention is directed to the fact that in no instance will a case of 
venereal disease in the person of a discharged member of the military or naval 
forces of the allied or associated powers be accepted for treatment by any hos- 
pital, Government owned or opera Led or contract, without first obtaining spe- 
cific permission from the Chief Medical Advisor of the Bureau of War Risk In- 
surance. 

Failure to observe the above procedure can only result in monetary loss to 
the bureau and can but prove a potential source of irritation and misunder- 
standing between the bureau, the Department of Soldiers' Civil Reestablish- 
ment and other similar institutions. 

You are directed in future to be guided by the above-quoted letter ; 
namely, that no discharged disabled man of the military or naval 
forces of any of the allied or associated powers should be taken for 
treatment except for disabilities of service origin or which have been 
aggravated by his military service, and that in no instance will a 
case of venereal disease in the person of a discharged member of the 
military or naval forces of the allied or associated powers be ac- 
cepted for treatment by any hospital. Government owned or operated 
or contract, without first obtaining specific authority from the Chief 
Medical Advisor, Bureau of War Eisk Insurance. 

H. S. Gumming, 
Surgeon General, 



Relative War Risk Transportation Requests. 

Teeastiry Department, 

BuREAIT OF THE PuBLIC HeALTH SeRVICE, 

Washington^ April 26, 1920. 

Bureau Circular Letter No. 217. 

To medical oncers of the Public Sealth Service, and others con- 
cerned: 

You are advised that the Bureau of War Eisk Insurance states 
that considerable confusion and delay in the payment of certain 
vouchers in that bureau has arisen on account of war risk trans- 
portation requests (symbol " TWR ") being used for travel on busi- 
ness of the Public Health Service, and a notation made to tke effect 
that charges are to be billed against the Public Health Service, this 
procedure being authorized in paragraph 2 of Public Health Service 
unnumbered bureau circular letter dated November 12, 1919, which 
reads as follows : 

It is hereby directed that under such circumstances transportation requests 
showing that the expenditures are chargeable to the Public Health Service be 
used. This may be accomplished with the War Risk Insurance request by 
striking out the words " Charges to be billed against war risk insurance," and 



187 

inserting the words, "Charges to be billed against Public Health Service," so 
that there need be no delay even if Public Health Service transportation re- 
quests are not on hand. 

Paragraph 2 of unnumbered bureau circular letter dated Novem- 
ber 12, 1919, quoted above, is hereby annulled, and in future war- 
risk insurance transportation requests (symbol "TWR") should be 
issued only to beneficiaries of the War Eisk Insurance Bureau, when 
traveling at the expense of that bureau, and to attendants accom- 
panying such beneficiaries. 

H. S. Ctjmming, 
Surgeon General. 



Communications Originating With Subordinate Personnel — Advice Regarding 
Pay and Accrued Leave Upon the Transfer of Personnel. 

Treastjrt Department, 
Btjkeatj of the Ptjblic Health Servige, 

Washington, ApHl 29, WW. 

Bureau Circular Letter No. 218. 

Medical officers, United States Public Health Service, and others 

concerned : 

Attention is directed to the following instructions governing the 
forwarding to the bureau of communications originating with sub- 
ordinate personnel at stations of the service and transfer of officers 
and other employees. 

(l),No communications originating with subordinate personnel 
at stations of the service shall be forwarded to the bureau for con- 
sideration without making a definite recommendation as " Respect- 
fully forwarded, recommending approval or disapproval " and stat- 
ing the reason for such action, except in cases where it is obvious that 
no recommendation is necessary. 

(2) All communications addressed to officers of a higher authority 
shall be signed by the officer in charge, and not by a subordinate 
member of the personnel at stations of the service, " By direction 
of the officer in charge," or similar expression, 

(3) When transfers of officers or other employees are made from 
one station to another, the officer in charge shall immediately notify 
by letter the officer in charge of the station to which the transfer 
is made, giving the name, rank, or grade, rate of pay, date when last 
paid, and amount, if anj^, of unused leave which may have accrued 
to the credit of the officer or employee at the station from which 
transferred. 

H. S, Gumming, 
Surgeon General. 



188 

Use of Arsenic Preparations in Treatment of Syphilis. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, May 1%, 1920. 

Bureau Circular Letter No. 219. 

Medical officers, U. S. Public Health Service and others concerned: 

Your attention is invited to the extensive exploitation through 
advertisements in professional journals and otherwise of various 
arsenic preparations which are not related to the arsphenamine 
group. The preparations referred to are sold with claims in regard 
to their value in the treatment of syphilis, which are unwarranted. 

In the opinion of this office it is in the interest of all concerned 
that the subcutaneous, intramuscular, or intravenous use of arsenic 
in the treatment of syphilis be confined to preparations of the 
arsphenamine group, as these agents are of established value and are 
produced under the regulations of the Public Health Service. The 
following firms are now licensed for the manufacture of arsphena- 
mine and neo-arsphenamine : 

Dermatological Research Laboratories, 1720 Lombard Street, 

Philadelphia, Pa. 
H. A. Metz Laboratories, 122 Hudson Street, New York, N. Y. 
Diarsenol Co. (Inc.), Buffalo, N. Y. 
Takamine Laboratories, Clifton, N. J. 

The Lowy Laboratory, of Newark, N. J., has been granted a license 
to prepare a stable solution of arsphenamine. 

It is not the desire of the bureau to limit clinicians in the choice 
of agents of recognized worth, but in the case of arsenic prepara- 
tions, not members of the arsphenamine group, the available evi- 
dence indicates that their routine use is inadvisable in the treatment 
of syphilis. If it is desired to use any of these preparations in a 
purely experimental way previous authority from the bureau should 
be secured. Applications for this authority should be accompanied 
by a statement as to the composition of the drug, including the struc- 
tural formula and the reason for its use. All information available 
on the value of the preparation should be forwarded. 

Receipt of this circular should be acknowledged and marked " V. 
I). Division." 

H. S. CUMMING, 

Surgeon General. 



189 

Pay Increase, Transportation of Families, and Commutation of Heat and 
Light Under Act of May 18, 1920. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, May 28, 1920. 

Bureau Circular Letter No. 220. 

To officers of the Puhlic Health Service: 

1. An act approved May 18, 1920, contains the following provi- 
sions : 

That commencing January 1, 1920, commissioned officers of the Army, Navy, 
and Marine Corps and Pviblic Health Service shall be paid, in addition to all 
pay and allowances now allowed by law, increases at rates per annum as 
follows : Colonels in the Army and Marine Corps, captains in the Navy, and 
assistant surgeons general in the Public Health Service, $600; lieutenant 
colonels in the Army and Marine Corps, commanders in the Navy, and senior 
surgeons in the Public Health Service, $600; majors in the Army and Marine 
Corps, lieutenant commanders in the Navy, and surgeons in the Public Health 
Service, $840 ; captains in the Army and Marine Corps, lieutenants in the Navy, 
and passed assistant surgeons in the Public Health Service, $720 ; first lieu- 
tenants in the Army and Marine Corps, lieutenants (junior grade), acting as- 
sistant surgeons and acting assistant dental surgeons in the Navy, and assistant 
surgeons in the Public Health Service, $600 ; second lieutenants in the Army 
and Marine Corps and ensigns' in the Navy, $420 : Provided, That contract 
surgeons of the Army serving full time shall receive the pay of a second 
lieutenant. 

Sec. 2. That the rights and benefits prescribed under the act of April 16, 1918, 
granting commutation of quarters, heat, and light during the present emergency 
to officers of the Army on duty in the field are hereby continued and made 
effective until June 30, 1922, and shall apply equally to officers of the Navy, 
Marine Corps, Coast Guard, and Public Health Service: Provided, That such 
rights and benefits as are prescribed for officers shall apply equally for enlisted 
men now entitled by regulations to quarters or to commutation therefor. 

Sec. 9. That nothing contained in this act shall be construed as granting any 
back pay or allowances to any officer or enlisted man whose active service 
shall have terminated subsequent to December 31, 1919, and prior to the 
approval of this act unless such officers or enlisted men shall have been recalled 
to active service or shall have been reenlisted prior to the approval of this act. 

Sec. 11. * * * Provided, That hereafter longevity pay for officers in the 
Army, Navy, Marine Corps, Coast Guard, Public Health Service, and Coast and 
Geodetic Survey shall be based on the total of all service in any or all of said 
services. 

Sec. 12. That hereafter when any conrmissioned officer, noncommissioned 
officer of the grade of color sergeant and above, including any noncommissioned 
officer of the Marine Corps of corresponding grade, warrant officer, chief petty 
officer, or petty officer (first class) having a wife or dependent child or children 
is ordered to make a permanent change of station the United States shall 
furnish transportation in kind from funds appropriated for the transportation 
of the Army, the Navy, the Mai'ine Corps, the Coast Guard, the Coast and 
Geodetic Survey, and the Public Health Service to his new station for the 
wife and dependent child or children: * * * Provided further, That if the 
cost of such transportation exceeds that for transportation from the old to the 



190 

new station the excess cost shall be paid to the United States by the officer 
concerned : Pt^ovided further. That transportation supplied the wife or depend- 
ent child or children of such officer to or from stations beyond the continental 
limits of the United States shall not be other than by Government transport 
if such transportation is available : * * *_ 

Sec. 13. That the provisions of sections 1, 3, 4, 5, and 6 of this act shall 
remain effective until the close of the fiscal year ending June 30, 1922, unless 
sooner amended or repealed : * * *. 

Sec. 14. That nothing contained in this act shall operate to reduce the pay 
or allowances of any officer or enlisted man on the active or retired list: 
Provided, That the allowances and gratuities now authorized by existing law 
are not changed hereby, except as otherwise specified in this act. 

2. The increase of pay provided for by this act is temporary, and 
amounts expended under the authority of the act should be separately 
accounted for. In making out pay rolls, amounts paid as " increase 
of compensation " under the act should be stated separately. 

3. The act provides for increase of pay from January 1, 1920, but 
the amount of the increase for the months of January to May, in- 
clusive, should be entered on a supplemental roll and should not be 
included in the regular pay roll for May, 1920. 

4. New pay rolls, which provide a separate column in which to 
enter the increase under the act, are being prepared. Commissioned 
officers of the regular corps should use Form 1948 and reserve officers 
should use Form 1948A. 

5. Until the new pay rolls become available the pay rolls now in 
use shall be continued with the following change: Form 1948, pay 
and commutation roll for commissioned officers and pharmacists, 
shall have a line drawn in the space under " Name and designation," 
about 1 inch from the present line, and in the box at the head of the 
column shall be written " Increase of compensation, act May 18, 
1920," and the amounts shall be totaled at the foot of the column. 



Name and designation. 



Increase 
of com- 
pensation, 
act May 
18, 1920. 



Fay. 



Commuta- 
tion of 
quarters, 
etc. 



Amount 
due. 



Date, 
etc. 



Remarks. 



6. The roll for reserve officers shall be submitted on Form 1952B 
as heretofore, with the additional column like that made on Form 
1948, as follows : 



Name, designation, etc. 



Increase 
of com- 
pensation, 
act May 
18, 1920. 



Regular 
compen- 
sation. 



Increase 
of com- 
pensation. 



Total 
paid. 



Date, 
etc. 



Remarlcs. 



7. Every officer of the Public Health Service on duty in the field 
or on active duty beyond the territorial jurisdiction of the United 



191 

States who maintains a place of abode for a wife, child, or depend- 
ent parent at a place where quarters are not available is entitled to 
commutation for quarters, heat, and light at the place where he main- 
tains such place of abode while occupied by such wife, child, or de- 
pendent parent, without regard to personal quarters furnished him 
elsewhere. Officers entitled to this commutation between January 1, 
1920, and May 31, 1920, should make claim for the same on an indi- 
vidual pay voucher. 

8. Officers assigned to duty within the territorial jurisdiction of 
the United States and stationed under conditions which make it im- 
practicable to furnish them at Government expense with their au- 
thorized allowance of quarters, or when assignment to such duty at 
such stations is obviously for so short a period that it w^ould not be 
practicable for such of these officers having dependents to establisli 
their dependents at such stations, such officers shall be considered as 
on field duty within the meaning of the act of April 16, 1918. 

9. When an officer of the class specifically provided for by section 
12 of the act desires to secure transportation for his wife or depend- 
ent child or children to his new station under the provisions of that 
section, a transportation request should be made out in all cases. 
Travel prior to May 18, 1920, is not included within the terms of the 
act. 

H. S. Gumming, 
burgeon General. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington., June 22, 1920. 

Bureau Circular Letter No. 221. 

To reserve officers of the Public Health Service: 

In view of the conditions and circumstances surrounding the pres- 
ent status of reserve officers in the Public Health Service, I deem it 
wise to express to you certain personal opinions, which represent 
essentially what I earnestly desire to put into effect so far as the 
limitations of my office will permit. 

While the medical care and treatment of ex-service men and women 
may for a time be involved in certain legal uncertainties, nevertheless, 
in my judgment, this duty will remain a permanent and important 
part of the work of the Public Health Service, as well as the exten- 
sion of public health activities, and the reserve officers who have been 
or will be appointed in this service will be needed indefinitely for 
the performance of this important work. 

The Public Health Service has now, and will have, a real and urgent 
need of the personnel composing the reserve officers, and it is my 



192 

earnest desire to retain the service of this personnel. In order for 
the service to properly function in this important work, it is con- 
sidered absolutely essential to reorganize the existing personnel. In 
this reorganization, it is contemplated and desired to amalgamate 
the regular and reserve officers into one corps, and reserve officers 
will be selected largely upon their service records and taken into the 
regular establishment if the proper legislation can be secured and 
made effective. I shall strive to make this policy effective as soon 
as possible. 

I feel justified, therefore, in saying to the reserve officers of the 
Public Health Service that, while their present status may not be 
as desirable as they would wish, yet the future promises an interest- 
ing and useful field of activity, with the establishment of a status 
which will be acceptable to all of them. 

Hugh S. Gumming, 

Surgeon General. 



Granting of Commissary Privileges to Officers of the Public Health Service. 

Treasury Department, 
Bureau of the Public Health Service, 

'Washington^ June 30^ 1920. 

Bnreaa Circular Letter No. 222. 

(Amending Bureau Circular Letter No. 211.) 

To officers of the Public Health Service: 

1. A deficiency act approved March 6, 1920, provides as follows: 

Hereafter officers of the Public Health Service may purchase quartermaster 
supplies from the Army, Navy, and Marine Corps at the same prices as charged 
officers of the Army, Navy, and Marine Corps. 

2. In an opinion rendered by the Judge Advocate General of the 
Army under date of June 16, 1920, the term " officers " as used in 
the act has been interpreted as meaning only commissioned officers, 
so far as the provisions of the act affect the Public Health Service. 

3. The following extracts from the opinion of the Judge Advocate 
General of the Army are published for the information and guidance 
of all interested persons in the service. (Following are quotations 
from statutes) — 

it is apparent that Congress has in mind two classes, viz : Officers and em- 
ployes ; that by the term officers it meant commissioned officers appointed by 
the President and confirmed by the Senate ; and that by the term employes it 
meant all other persons whether appointed by the Surgeon General or em- 
ployed generally in the Public Health Service. 

The provisions of the statute under specific consideration (act of Mar. 6, 
1920, Pub. 155, 66th Cong., p. 6) plainly supports and is in line with such 
construction. 

He 4: # H: « ^ $ 



193 

It is the opinion of this office, therefore, that only commissioned officers of the 
Public Health Service are authorized, under the provisions of the act of March 
6, 1920, to purchase quartermaster supplies from the Army, Navy, and Marine 
Corps at the same price as charged officers of the Army, Navy, and Marine 
Corps. 

H. A. White, 
Colonel, Judge Advocate, Chief, Administrative Lavyyer. 

4. It will be noted that the following clause appears in the above 
quoted opinion " That by the term officers it meant commissioned 
officers appointed by the President and confirmed by the Senate." 
Although commissioned officers of the Public Health Service Reserve 
are appointed by the Secretary of the Treasury by virtue of au- 
thority delegated to him by the President, the appointment of such 
officers is not subject to confirmation by the Senate. It is believed, 
however, that the term " commissioned officers of the Public Health 
Service," as used by the Judge Advocate General of the Army, may 
reasonably be held and construed so as to include reserve officers, 
inasmuch as the joint resolution, sixty-fifth Congress, first session, 
provides in part as follows — 

that for the purpose of securing a reserve for duty in the Public Health Service 
in time of national emergency there shall be organized under the direction of 
the Secretary of the Treasury, under such rules and regulations as the Presi- 
dent may prescribe, a Reserve of the Public Health Service. The President 
alone shall be authorized to appoint and commission as officers in the said 
reserve such citizens as, upon examination prescribed by the President * * *. 

5. It seems apparent from a perusal of the above that the only 
persons within the Public Health Service who may take advantage 
of the commissary purchasing privilege are commissioned officers of 
the Regular and Reserve Corps. 

J. C. Perry, 
Acting Surgeon General. 



Rescission of Certain Instructions Relative to Preparation and Submission of 
Pay Rolls Under the Provisions of the Act of May 18, 1920. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ June 30, 19W. 

Bureau Circular Letter No. 223. 

(Amending Bureau Circular Letter No. 220.) 

To o-fficers of the Public Health Service: 

1. So much of Bureau Circular Letter No. 220 dated May 28, 

1920 (par. 4 and first sentence of par. 6), as requires the use of a new 

pay-roll form, designated as Form 1948 A, for officers of the Eeserve 

Corps of the Public Health Service, is hereby rescinded, inasmuch 

14330°— 21 13 



194 

as the Comptroller of the Treasury has disapproved the use of a 
separate form of pay roll for this class of officers. Form 1948 is 
being revised so as to show no appropriation designation at the head 
of the sheet. In order to insure the expeditious auditing of pay rolls, 
the names of Regular and Reserve Corps officers will be submitted on 
separate rolls (i. e., the names of Regular and Reserve officers should 
not appear on the same roll) with the space for the designation of 
the appropriation left blank. Until Form 1948 (revised) is ready 
for distribution to stations of the service, the pay accounts of 
Regular Corps officers and pharmacists will be submitted on Form 
1948, and the accounts of Reserve officers on Form 1952 B, as pro- 
vided in Bureau Circular Letter No. 220, paragraphs 5 and 6. 

J. C. Perry, 
Acting Surgeon General. 



Classification of Employees and Preparation of Pay Rolls for August and 
Subsequent Months in Accordance With Provisions of Retirement Act 
Approved May 22, 1920. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, July 21, WW, 

Bnrean Circular Letter No. 224. 

To district supervisors, medical oficers in charge of hospitals, quaran- 
tine and immigration stations, United States Public Health 
Service : 

1. In the preparation of pay rolls for periods of service com- 
mencing August 1, 1920, and subsequently all officers of the service 
charged with the duty of certifying to the correctness of pay rolls 
covering services of employees under their supervision, will be guided 
by the following requirements : 

The following classes of employees to be credited with 97| per cent 
of basic compensation (to be computed on basis salary, not including 
any bonus to which entitled) — 

{a) All acting assistant surgeons, acting assistant dental surgeons, 
and internes, appointed as result of competitive civil-service ex- 
amination, whose compensation is in excess of $300 per annum, ap- 
pointed for duty at stations for which the Civil Service Commission 
maintains lists of eligibles. 

(&) All attendants appointed as result of competitive civil-service 
examination or given a competitive classified status by Executive 
order, employed at quarantine stations, whose compensation is in 
excess of $75 per month; all attendants employed elsewhere in the 
Public Health Service, appointed as result of competitive civil-service 



195 

examination or given a competitive classified status by Executive 
order, whose compensation is in excess of $50 per month; and all 
other emploj^ees, including those persons appointed to scientific, 
technical, stenographic, and clerical positions as result of open com- 
petitive civil-service examinations or given a competitive classified 
status by Executive order whose compensation is in excess of $50 
per month. 

The following classes of employees are not subject to the provisions 
of act of May v^, 19W, and should he credited with the total amount 
of basic compensation on future pay rolls, 

{c) All attending specialists (consultants) and local physicians 
appointed permanently or for limited periods as acting assistant 
surgeons, without regard to open competitive examination, for duty 
at stations or localities where, in the opinion of the Civil Service 
Commission, the establishment of registers of eligibles is imprac- 
ticable. 

{d) All scientific assistants appointed temporarily for periods 
not to exceed six months or longer, with the prior approval of the 
Civil Service Commission, in investigations of contagious or in- 
fectious diseases and matters pertaining to the public health; any 
person temporarily employed in the work of preventing or sup- 
pressing a threatened or actual epidemic of any disease for which 
the appropriation for the prevention of epidemics is available; all 
persons assigned, but not permanently appointed through examina- 
tion, to classified positions during treatment or convalescence at 
Government sanitariums ; all other employees whose salaries are not 
in excess of $50 per month and whose positions are excepted from 
the competitive requirements of the civil-service rules ; all attendants 
whose compensation is not in excess of $50 p..r month and whose 
positions are excepted from the competitive requirements of the civil- 
service rules ; and unskilled laborers. 

2. In individual cases when doubt may exist ae to the proper 
classification of an employee within the meaning of the act, a report 
will be promptly submitted to the bureau, giving all available facts 
and including manner of appointment in each particular case. Upon 
receipt of same, the record of the person whose status is doubtful 
will be investigated with a view to the determination of the exact 
classification of the specific case. 

8. Employees not appointed through open competitive examination 
or classified by the civil-service rules or by Executive order do not 
come within the scope of the retirement act. 

H. S. CUMMING, 

Surgeon General. 



196 

Forms of Pay Rolls for Retirement Deductions. 

Treasuey Department, 
Bureau of the Public Health Service, 

Washington^ August 13^ 1920. 

Bureau Circular Letter No. 225. 

(Supplementing Bureau Circular Letter No. 224.) 

To oificers of the Puhlic Health Service: 

1. In order that officers of the Piibhc Health Service may be en- 
abled to follow a uniform system in the preparation of employees' 
pay rolls covering periods of service commencing August 1, 1920, 
and subsequently, so as to comply with the provisions of section 8, 
act of May 22, 1920. the following instructions are published for the 
guidance of all concerned. 

2. All employees of the field service may be grouped under two 
separate divisions for the purpose of computing pay, namely : Classi- 
fied and unclassified. The term " clasified employees " within the 
meaning of the retirement act, includes only those employees who 
have been appointed as the result of civil service examination and 
certification from registers of eligibles. All employees who have not 
been appointed in the above manner are not affected by the act of 
May 22, and are, therefore, not subject to any pay deduction. The 
list of classified and unclassified positions included in Bureau Circu- 
lar Letter No. 224, dated July 21, was not intended to include the 
incumbents of classified positions who have been apointed thereto 
without regard to civil service rules and regulations governing 
such appointments. Unless it can be unquestionably established that 
employees have a classified civil-service status, they will be credited 
with entire amount of basic compensation on future pay rolls. 

3. For all services rendered subsequent to July 31, 1920, the pay 
accounts of both classified and unclassified employes will be prepared 
on Form 1952 B. For all employees the column headed "Regular 
compensation" should show the entire amount (100 per cent) of 
basic compensation for the period of service. The amounts shown 
in the column headed " Increase of compensation " will be as hereto- 
fore for both classified and all other employees. In the column 
headed " Total paid " the following insertion should appear on all 
future rolls : " Less '2^ per cent base pay retirement act." For classi- 
fied employees the amount shown under " Total paid " should be equal 
to 97^ per cent of base pay plus any bonus authorized. For all other 
employes amounts will be shown as heretofore with the following 
remark inserted in " Remark " column opposite each name : " Not 
within act May 22, 1920." 



197 

It is expected that revised salary tables will be received for dis- 
tribution to field stations in the near future. Until they are received 
each individual pay account will have to be computed separately. 

H. S. Gumming, 
Surgeon General. 



Procedure to be Followed by Nominating Officers in Making Recommenda- 
tions for Appointments to Classified Positions. 

Teeasurt Department, 
Bureau or the Public Health Service, 

Washington^ August 28^ 1920. 

Bureau Circular Letter No. 226. 

To district supervisors^ medical officers in charge of hospitals^ quaran- 
tine and immigration stations, United States Public Health 
Service : 

1. The attention of the bureau has recently been called to the ex- 
istence of certain irregularities occasioned by the failure of nomi- 
nating officers at field stations to observe and comply ^with the 
requirements laid down in Civil Service Rules and Regulations, rela- 
tive to the procedure to be followed prior to the preparation and 
transmittal of recommendations for the appointment of persons to 
positions, which, by reason of the character of the duties involved, 
are within the competitive classified service. 

2. The following designated positions may be regarded as classified 
Tinder Civil Service Rules and Regulations : 

{a) Acting assistant surgeons, acting assistant dental surgeons 
where the compensation exceeds $480 per annum. 

(&) Attendants at quarantine stations in cases where the compen- 
sation is in excess of $75 per month; all attendants employed else- 
where in the Public Health Service, in cases where the compensation 
is in excess of $50 per month ; scientific, technical, stenographic and 
clerical positions, in cases where the compensation is in excess of $50 
per month. 

All positions which apparently can not be included under the 
above classification may be regarded as without the classified civil 
service ; and appointments thereto may be recommended at any time 
the interests of the service so require, without the reference of such 
cases to civil service district secretaries or to the Civil Service Com- 
mission for approval. 

3. In accordance with a recent recommendation of the Surgeon 
General, a single register has been established by the Civil Service 



198 

Commission at Washington for each of the following-designated po- 
sitions, from which future certification for appointments will be 
made: 

Acting assistant surgeons. 

Acting assistant dental surgeons. 

Bacteriologists. 

Administrative assistants. 

X-ray technicians. 

Reconstruction aids. 

Chemists. 

Nurses. 

Dietitians. 
Whenever a person is recommended for appointment to any of 
the above (in cases in which the probable period of employment is 
greater than 30 days) a request for the certification of an eligible 
from the appropriate register will accompany the nomination to the 
bureau. It should be ascertained by the nominating oiRcer whether 
the appointee desires to qualify under civil-service rules for possible 
permanent" appointment. Should he desire to do so, an application for 
examination (Form 1312) may be executed and submitted by the ap- 
plicant within 30 days from the date of appointment, or preferably at 
time of temporary appointment. A supply of Form 1312 may be ob- 
tained from the office of the civil service district secretary most ac- 
cessible to the appointing officer. (See list of addresses of civil 
service district secretaries herewith.) 

4. Before any action is taken toward the nomination of persons 
for appointment in any classified position, other than those desig- 
nated in paragraph 3 herein, the secretary of the civil service dis- 
trict in which appointments are contemplated should be consulted 
if no delay is occasioned by this action. If he can not be reached 
promptly the desired employee can be nominated and the district 
secretary notified in writing that an employee has been put on duty, 
giving the name of appointee, together with rate of compensation, 
date of appointment, and duties of said incumbent, and stating in 
the letter that the nominee has been instructed to qualify for the 
vacancy under civil-service rules and regulations; or, if no eligibles 
for the position or positions to be filled are pending on register, the 
approval of the civil service secretary concerned should be obtained 
in the same manner when said temporary position is filled. It should 
be understood that temporary appointments are only authorized for 
periods not to exceed six months, and are subject to extension only 
in the event that at the expiration of that period no civil-service 
eligibles are available for certification. Furthermore, should a regis- 
ter of eligibles be established during the incumbency of a temporary 



199 

appointee in a classified position, the regulations require that the tem- 
porary appointee take the qualifying examination or be replaced by 
a person whose name appears on an eligible list. Nominating offi- 
cers should at all times cooperate with the civil service secretaries 
of their respective districts in matters pertaining to contemplated 
appointments to classified positions. 

5. At present a number of field employees of this service are occu- 
pying classified positions for which they have never qualified 
through civil-service examination. The existence of sucli a condition 
is obviously in violation of civil-service rules and regulations gov- 
erning appointments, and it is desired that every possible effort be 
made by the appointing officers to correct same by familiarizing 
themselves with the requirements of the rules and regulations gov- 
erning appointments and by close cooperation with the respective 
civil-service district secretaries. All employees occupying classified 
positions for which they have not qualified through civil-service 
examination and certification should be required to apply for ex- 
amination at the earliest practicable date. The certification of these 
persons for appointment in most cases is assured soon after successful 
examination because of the fact that there are very few names await- 
ing certification from registers of eligibles at the present time. 

6. The following list of addresses of the secretaries of the various 
civil-service districts are published for the information of all con- 
cerned : 

CIVIL-SEEVICE DISTEICTS. 

First district. — Headquarters, Boston, Mass. : Maine, New Hampshire, Ver- 
mont, Massachusetts, Rhode Island, and Connecticut. 

Second district. — Headquartei's, New York : New York and the counties of 
Bergen, Essex, Hudson, Middlesex, Morris, Passaic, Sussex, and Union in the 
State of New Jersey. 

Third dist7~ict. — Headquarters, Philadelphia: Pennsylvania, Delaware, and 
the counties of Atlantic, Burlington, Camden, Cape May, Cumberland, 
Gloucester, Hunterdon, Mercer, Ocean, Salem, Somerset, and Warren in the 
State of New Jersey. 

Fourth district. — Headquarters, Washington, D. C. : Maryland, West Vir- 
ginia, Virginia, North Carolina, and the District of Columbia. 

Fifth district. — Headquarters, Atlanta, Ga. : South Carolina, Georgia, Ala- 
bama, Florida, Mississippi, and Tennessee. 

Sixth district. — Headquarters, Cincinnati, Ohio: Indiana and Kentucky. 

Seventh district. — Headquarters, Chicago; 111. : Wisconsin, Michigan, and 
the counties of Boone, Bureau, Carroll, Cook, Dekalb, Dupage, Ford, Grundy, 
Henderson, Henry, Iroquois, Jo Daviess, Kane, Kankakee, Kendall, Knox, Lake, 
La Salle, Lee, Livingston, McHenry, Marshall, Mercer, Ogle, Peoria, Putnam, 
Rock Island, Stark, Stephenson, Warren, Whiteside, Winnebago, and Woodford, 
in the State of Illinois. 

Eighth district.— Ueadquarters, St. Paul, Minn.: Minnesota, Nortli Dakota, 
Nebraska, South Dakota, and Iowa. 



200 

Ninth district. — Headquarters, St. Louis, Mo. : Kansas, Missouri, Oklahoma, 
Arkansas, and tlie counties of Adams, Alexander, Bond, Brown, Callioun, Cass, 
Champaign, Christian, Clark, Clay, Clinton, Coles, Crawford, Cumbei'land, 
Dewitt, Douglas, Edgar, Edwards, Effingham, Fayette, Franklin, Fulton, 
Gallatin, Greene, Hamilton, Hancock, Hardin, Jackson, Jasper, JeL'erson, Jer- 
sey, Johnson, Lawrence, Logan, McDonough, McLean, Macon, Macoupin, Madi- 
son, Marion, Mason, Massac, Menard, Monroe, Montgomery, Morgan, Moultrie, 
Perry, Piatt, Pike, Pope, Pulaski, Randolph, Richland, St. Clair, Saline, Sanga- 
mon, Schuyler, Scott, Shelby, Tazewell, Union, Vermilion, Wabash, Washing- 
ton, Wayne, White, and Williamson, in the State of Illinois. 

Tenth district. — Headquarters, New Orleans, La. : Louisiana and Texas. 

Eleventh district. — Headquarters, Seattle, Wash. : Wyoming, Montana, Ore- 
gon, Idaho, Washington, and Alaska. 

Tivelfth district. — Headquarters, San Francisco, Calif. : California, Nevada, 
Colorado, New Mexico, Arizona, and Utah. 

H. S. Gumming, 
/Surgeon General. 



Shipment of Tissue of Persons or Animals Suspected of Suflfering From 

Bubonic Plague. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, August 30, 1920. 

Bureau Circular Letter No. 227. 

To Officers of Puhlic Health Service and State and local health 

officers : 

Owing to the appearance of plague in several American ports 
it is important that all cases of suspected plague, both in man and 
animals, be subjected to a bacteriological examination. 

1. The following material from persons or rodents suffering from 
plague may be sent to laboratories : 

HUMAN cases (LIVING), 

{a) Pus or gland fluid from buboes, aspirated by syringe or 
collected after incision, on agar slants. 

(&) Portions of tissues affected, removed at operation, in steril- 
ized bottles, securely stoppered. 

(c) Blood specimens, in sterilized, sealed glass ampules or test 
tubes. 

{d) Cultures of suspected organisms, on agar slants. 

human cases (NECROPSY). 

{a) Portions of the affected tissues — preferably bubo, lung, and 
spleen — in sterilized glass bottles, securely stoppered. 



201 

RODENTS. 

(a) The whole rodent carcass, in fruit preserving jar. 

2. Do not place tissues, nor rodents, in a preservative. The bac- 
teriological diagnosis of plague rests upon the production of the 
disease in laboratory animals and the isolation and growth of the 
causative organism, Bacillus pestis. Any preservative that kills 
this organism will defeat the purpose of the examination. If de- 
composition of the specimen is feared it may be placed in a tight con- 
tainer and this in turn surrounded by ice in a larger container, pref- 
erably of wood. Every specimen should be plainly marked, prefer- 
ably by ordinary pencil, showing the date and the exact location from 
which it was taken. 

3. The shipper must make certain that the specimen is packed in 
such manner as to prevent possible danger to those handling the same, 
provided the package is properly handled. 

In this connection it is necessary that specimens be wrapped in 
sufficient cotton or other absorbent material to prevent leakage of 
fluid from the container should the glass be broken. 

THE FOLLOWING INSTKUCTIONS SHOULD BE EXPLICITLY OBSERVED. 

1. Ship hy express. — Federal laws prohibit the shipping of plague- 
infected material or cultures by mail. 

2. Do not make packages too small, as small packages are more 
likely to be lost in transit or overlooked. 

3. Each package should be marked as follows: "Notice. — This 
package contains perishable specimens for bacteriological exami- 
nation. Please expedite !" 

Material should be sent to the nearest one of the following service 
laboratories, which will make examination and report thereon : 

1. The Hygienic Laboratory, Twenty-fifth and E Streets NW., 
Washington, D. C 

2. U. S. Plague Laboratory, No. 200 Duboce Street, San Francisco, 
Calif. 

3. U. S. Plague Laboratory, No. 525 St. Charles Street, City Hall, 
New Orleans, La. 

4. U. S. Plague Laboratory, Medical Department, University of 
Texas, Galveston, Tex. 

5. U. S. Plague Laboratory, State Department of Health Build- 
ing, Pensacola, Fla. 

6. U. S. Plague Laboratory, Beaumont, Tex. 

Eespectfully, 

H. S. CUMMING, 

Surgeon General. 



202 

Amending Bureau Circular Letter No. 206. 

Teeastjry Department, 
Bureau of the Public Health Service, 

Washington, August W, 1920. 

Bureau Circular Letter No. 228. 

To medical officers of the United States Public Health Service: 

Bureau Circular Letter No. 206, March 4, 1920, is amended to 
read as follows : 

You are advised that bureau similar letter of August 1, 1919, is 
hereby amended. 

Paragraph 1. The Motor Transport Corps, United States Army, no 
longer furnishes accessories, spare part, and repairs for vehicles of 
this service. 

Paragraph 2. The purchase of accessories, spare parts, and re- 
pairs in the open market without first obtaining bureau authority 
is discontinued with the following exceptions : 

In an emergency tires and tubes, spark plugs, skid chains, and 
light bulbs may be purchased without bureau authority. 

Spare parts may be purchased in the open market when necessary 
for immediate repairs without bureau authority if they may be 
procured locally; otherwise spare parts may be procured through 
the Purveying Depot, and in no case shall any station order parts 
from the factory manufacturing the vehicle. In cases where parts 
can only be obtained from the factory, delivery will be expedited 
and a more favorable price obtained when ordered through the 
Purveying Depot. 

All requisitions for replacement parts to be carried in stock at 
stations will be forwarded to the Purveying Depot for approval. 

Eepairs not exceeding $25 on motor vehicles owned by this service 
may be made without bureau authority when it is not practicable 
to do the work at the station. When extensive overhauling is neces- 
sary and the work can not be performed at the station a list show- 
ing the extent of repairs and replacements with estimated cost thereof 
shall be forwarded to the Purveying Depot for approval. 

It is not desired to make any changes in the present method of 
purchasing gasoline and repairing tires and tubes. 

This authority should not be considered as a cancellation of the 
approval of contracts made with dealers. 

Department approval of June 7, 1920, should be cited on bills as 
authority for all expenditures made in accordance with the fore- 
going instructions during the fiscal year 1921. 
Eespectfully, 

H. S. CUMMING, 

Surgeon General. 



203 

Pay and Allowances of Administrative Assistants Under the New Regulations 
Approved August 29, 1920. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, September 21, 1920. 

Bureau Circular Letter No. 229. 

To officers in charge, administrative assistants, and others concerned: 

The new regulations of the Public Health Service approved Au- 
gust 29, 1920, make decided changes in the pay and allowances of 
pharmacists, who are now for administrative purposes to be known 
as administrative assistants. 

The new regulations will reach the stations in mimeographed form 
within a few days. You are to be governed by these regulations, 
and your attention is especially called to the fact that by these new 
regulations administrative assistants are not entitled to subsistence 
or commutation for subsistence. Upon receipt of this letter you 
will discontinue issuing subsistence to pharmacists. 

Where pay rolls have been rendered at the old rates for service 
subsequent to August 28, 1920, supplementary pay roll vouchers 
should be rendered to cover the difference in pay and allowances. 
Where administrative assistants (pharmacists) have drawn rations, 
cooked or uncooked, due allowance should be made in the voucher 
for the cost of the same from and including August 29, 1920, to date 
of receipt of this letter. The deduction for rations drawn should be 
made at the rate of commutation for subsistence prescribed by the 
old regulations ($60 per month). 

In these supplementary vouchers paragraph 124 of the regulations 
should be cited as authority for additional pay, that being the num- 
ber of the new paragraph relating to the pay and allowances of 
administrative assistants. As authority for deducting cost of sub- 
sistence at the rate of $60 per month you will cite this letter. 

The Secretary of the Treasury will be requested to authorize a 
board to classify the administrative assistants other than pharmacists 
now in the Public Health Service. If the Secretary of the Treasury 
approves the recommendations of the board the provisions of the 
new regulations will be effective for administrative assistants other 
than pharmacists. 

Respectfully, C. C. Pierce, 

Acting Surgeon General. 



204 

Personnel Information in Connection With the Retirement Act Approved 

May 22, 1920. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ September '22^ 1920. 

Bureau Circular Letter No. 230. 

To district supervisors., medical officers in charge of hospitals^ quar- 
antine and hnmjigration stations, United States Public Health 
Service : 

1. In compliance with a request from the Treasury Department, 
your attention is invited to a letter quoted below from the Chief, 
Division of Appointments, and to the attached schedule addressed 
to Civil Service Commission in connection with the retirement act, 
approved May 22, 1920. 

2. You are requested to furnish the desired information on the 
attached schedule and forward same promptly to the Personnel and 
Accounts Division, United States Public Health Service, Washing- 
ton, D. C, in an envelope marked " Retirement " in the lower left- 
hand corner : 

By direction of the Secretary, you are advised that the department is in 
receipt of a request from the U. S. Civil Service Commission for tlie following 
information to be used in connection with the retirement act. * * * : 

1. Number of persons engaged upon clerical, supervisory, professional, and 
technical work (all employees not otherwise covered, excluding mechanics and 
unskilled laborers). 

2. Number of mechanics, helpers, skilled laborers, and others engaged upon 
work requiring training and physical ability rather than education and mental 
ability. 

3. Number of persons engaged as mere unskilled manual laborers, including 
charwomen. 

J. E. Harper, 
Chief, Division of Appointments, 

C. C. Pierce, 
Acting Surgeon General. 



Preference to be Given to Government-Inspected Establishments in Award- 
ing Contracts for Supplying Meats to Public Health Service Stations. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, October 6, 1920. 

Bureau Circular Letter No. 231. 

To tnedicol officers of the United States Public Health Service and 

others concerned: 

Officers of the service, when soliciting proposals for the furnishing 
of meats to service stations, or when forwarding bids received to the 



205 

bureau, will bear in mind that it is the bureau policy to give pref- 
erence at ail times to those establishments that are subject to inspec- 
tion by representatives of the Bureau of Animal Industry, United 
States Department of Agriculture. 

In transmitting proposals received for the suppljdng of meats 
recommendations submitted therewith should include a statement as 
to the status of the various establishments concerned, especially as 
to whether such establishments are subject to inspection by repre- 
sentatives of the Bureau of Animal Industry or are otherwise under 
sanitary supervision. 

At those places where there are no Federal-inspected establish- 
ments recommendation as to the acceptance of proposal shall be gov- 
erned by consideration of the manner in which the products are 
prepared and handled in the various establishments. 
Eespectfully, 

H. S. Gumming, 
burgeon General, 



Rules Governing Telegraphic Messages. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, October 7, 1920. 

Bureau Circular Letter No. 232. 

To medical officers of the United States Public Health Service and 

other employees: 

The following rules are hereby promulgated to govern official mes- 
sages by telegraph, cable, or wireless in the Public Health Service : 

1. Whenever it is necessary for officers to use the telegraph on offi- 
cial business, they must take due care to make the messages as brief 
as is consistent with clearness. All useless words must be omitted. 
The telegraph must not be used when letters will accomplish the 
same purpose. 

2. Messages shall be signed only with the surname and official title 
of the sender. Where the title of the sender is not necessary for 
identification, it shall be omitted. This is ordinarily the case with 
Public Health Service officers telegraphing to the bureau or to other 
officers of the service. 

3. The necessary address and a signature are not counted or 
charged for ; the rates this year for Government messages are figured 
at 40 per cent commercial rate, commercial count. All messages 
from the field to the Treasury Department should be addressed to the 
bureau or through the Surgeon General. 



206 

4. Messages will be signed autographically and not by typewriter. 

5. The date a message is filed for transmission will be placed in the 
upper right-hand corner of the message. 

6. Messages will be indorsed " Official Business " by the sender 
with his name and title and telegraph identification card number. 
Also the appropriation from which the message is to be paid will be 
stated at the bottom of the telegram when practicable. 

7. Official messages that are not prepaid or sent as charge messages 
must be plainly marked " Official Business. Collect. Government 
Eate." 

8. Only messages that are strictly in the interest of this service 
will be indorsed to be paid from an appropriation of this service. 
Whenever it shall be necessary to send messages in the interest of the 
War Risk Insurance Bureau, the Federal Board for Vocational Edu- 
cation, and other, same will be sent " Government Rate, Collect," and 
not indorsed to be paid from Public Health Service appropriations. 
Officers of this service who work in cooperation with State health 
departments will be exceedingly careful that only messages pertaining 
strictly to United States Public Health Service will be sent at " Gov- 
ernment Rates," and charged to an appropriation of this service. 
All naessages sent in the interest of the State health departments 
and others will be indorsed to be sent at commercial rates and the 
activity to which they are chargeable indicated on the telegram. 

9. Telegrams to any private person or persons on which charges 
are to be collected at destination, and are not paj^able from public 
funds, must be marked " Collect, Commercial Rate." 

10. Government telegraph rates, established conformably to law, 
are intended to apply to official Government business exclusively, 
and no private individual, association, company, or corporation 
should in any way be benefited thereby. In case it is necessary to use 
the telegraph on any business in the special interest of any person or 
persons in which the Government has no interest, the party for 
whom the service is performed will be required to pay for the message 
both ways at commercial rates. 

It. Telegrams making application for leave of absence or extension 
of leave or of inquiry whether leave has been granted, and the re- 
plies made thereto by telegraph, are not official business and will not 
be sent or paid for at the expense of the service. 

12. All telegrams, except those of a nature sufficiently ui^ent to 
demand immediate attention, will be filed for transmission as night 
messages at night rates, and this will be plainly indicated on the face 
of the message. In some instances, telegrams sent from the field to 
the department in Washington, or vice versa, as day messages, are re- 
ceived by the addressee after office hours and not acted upon until 



207 

the following morning with consequent needless expense to the 
Government, 

13. When there is doubt as to the advisability of filing a telegram 
to a distant point as a night message, consideration will be given to 
the difference in time (in some cases several hours) between the two 
points; the length of time, usually an hour or more, required for 
transmission and delivering telegrams; and the closing time of the 
office to which the message is addressed. 

14. As a check against errors or omissfions, an addressee, especially 
an officer in the field, immediately upon receipt of a telegram, will 
count the words and compare his count with the number entered in 
the upper m'argin of the telegraph blank. If a discrepancy occurs, 
request should be made upon the telegraph company for a repetition 
of the message, without additional cost to the Government. " Col- 
lect" messages show an extra word in the number of words given 
in the upper margin, but this is not billed against the Government. 

16. Officers should register their names and addresses with the 
telegraph offices wherever stationed, even temporarily, in order that 
messages addressed to them by their surnames only may reach them 
promptly. 

16. Each officer or employee of this service who is authorized to 
send Government official telegrams will be supplied with an identi- 
fication card from the telegraph companies. These identification 
cards can be obtained on request from the bureau. Upon the resig- 
nation or death of an officer, the card in his possession should be 
returned to the bureau. 

lY. This circular letter embodies the department regulations set 
forth in Treasury Department Circular No. 112, April 2, 1918, to 
which attention is directed. 

Hugh S. Cumming, 

Surgeon GeTieral. 

Instructions to Nurses, Aids, and Dietitians Relative to Reporting Date of 
Departure From Home or Elsewhere and Date of Arrival at First Station. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, D. C, Octoler 8, 1920. 

Bureau Circular Letter No. 233. 

To district supervisors, medical oficers in charge, United States 
Marine and Public Health Service hospitals, and others concerned: 
Upon receipt of this circular, you will cause each nurse, recon- 
struction aid, and dietitian on duty at the hospital or station under 
your charge to execute in duplicate the blank form attached hereto, 



208 

and forward same immediately to the Surgeon General (attention 
Personnel Section, Marine Hospital Division), 

The medical officer in charge will see that these forms are exe- 
cuted in detail and signed by the person executing it. The medical 
officer in charge will also sign this form, certifying to its correctness 
as shown by the station records. 

In the future all nurses, dietitians, and aids reporting for duty 
at the station under your charge as their first station shall forward 
to the bureau, through the medical officer in charge, the date upon 
which they left their home or elsewhere in compliance with their 
first order ordering them into active duty. This date is important, 
inasmuch as it is the actual date of appointment into the service. 
The medical officer in charge will be held responsible for the prompt 
receipt of this information by the bureau. 

H. S. Gumming, 

Surgeon General. 

Inclosures. 

Station Date 

(Name.) (Number.) 

To the Surgeon General, United States Public Health Service, 

Washington, D.C.: 
(Attention Personnel Section, Marine Hospital Division.) 

Name Designation 

Date of departure from home or elsewhere in compliance with first bureau 

order 

Date of arrival at first station for duty 

Name of first station 

Date of orders 

(Assigning to first station.) 



(In own handwriting.) 

I certify that the above statements are true and correct as shown by the 
/ hospital. 
Is 



records of this , station, 



(Medical oflacer in charge.) 



Requisitions for Blanks and Blank Books. 

Treasurt Department, 
Bureau of the Public Health Service, 

Washington^ October 19, 1920. 

Bnrean Circular Letter No. 234. 

To officers, United States Public Health Service, and others concerned. 

1. Requisitions for blanks and blank books shall be made quarterly 

on Form 1906, and shall be submitted in duplicate to the Surgeon 



209 

General, United States Public Health Service, Washington, D. C, 
attention chief clerk. In order to expedite the filling of these requi- 
sitions, they shall be forwarded from the various stations as follows : 
From stations in — 

Districts. Dates for submission. 

Nos. 1, 2, 3, 4, 5, and 6 January 1, April 1, July 1, October 1. 

Nos. 7, 8, 9, 10, 11, and 12 February 1, May 1, August 1, November 1. 

Nos. 13, 14, 15, 16, 17, and 18 March 1, June 1, September 1, December 1. 

2. When a supply of forms is needed at any time between the dates 
on which the quarterly requisitions are submitted, a supplemental 
requisition may be forwarded on Form 1906-A, requesting in each 
case only such quantities as may be needed pending the filling of the 
next regular quarterly requisition and stating the reason necessitat- 
ing the request. 

3. When blank forms which are not listed on Form 1906 are de- 
sired, the request should be made on Form 1906-A. 

4. In cases of emergency, telegraphic requests may be made. 

5. It is not the policy of the bureau to arbitrarily reduce quantities 
of forms requested by a district supervisor as he is considered the 
best judge of his own needs, and for that reason it is requested that 
careful scrutiny be given to each requisition submitted. 

Respectfully, 

H. S. Gumming, 
Surgeon General. 

> Instructions Concerning Stationery Requisitions and Invoices. 

Treasuey Department, 
Bureau of the Public Health Service, 

'Washington., October 20, 1920. 

Bareaa Circular Letter No. 235. 

To o-fftcers, United States Public Health Service, and others con- 
cerned: 

Eequisitions for waste-paper baskets, desk baskets, desk trays, etc. 
will hereafter be prepared on Form 1908 and forwarded to the pur- 
veying service. United States Public Health Service, Washington, 
D. G. The existing practice of preparing these requisitions on 
Forms 2162 and 2163 and transmitting them to the Surgeon General 
for the attention of the chief clerk will therefore be discontinued 
upon receipt of this communication. 

Ink, mucilage, " Dermax " or any other liquid likely to freeze can 
not safely be shipped during winter months. Requisitions for these 
articles should therefore not be submitted during the period from 
November 1 to April 1. A supply sufficient to last through the 
winter months should be requested during the summer. In the event 
14330°— 21 14 



210 

of an emergency which could not have been foreseen by ordinary 
care, these supplies may be purchased at the station and voucher 
submitted therefor in the usual manner as stated in the paragraph 
relative to emergency purchases on page D-6 of the Service Regula- 
tions approved August 29, 1920. This paragraph will be No. 441 
in the printed edition of the regulations and should be so cited in the 
voucher. 

Calendar pads and stands will be issued only during the months of 
December, January, February, March, and April. No such pads or 
stands should be requested for shipment during the period from 
May 1 to November 30. 

It has heretofore been the practice of the division of printing and 
stationery (Treasury Department) to forward direct to the officers 
in the field the stationery invoices covering material shipped to them. 
These invoices were then returned by the field officers to the division 
of printing and stationery. Hereafter these invoices will be sent 
direct from the bureau to the field officers. You are, therefore, in- 
structed to retumi all such invoices to the hureau^ attention chief 
clerh^ in order that a more accurate record may be kept. showing 
where the invoices are at all times. 

H. S. Gumming, 
Burgeon General. 

Instructions Relative to Printing and Marking Service Motor Transportation. 

Treasury Department, 
Bureau or the Public Health Service, 

W ashington.^ October 25, 1920. 

Bureau Circular Letter No. 236. 

To medical officers of the United States Public Health Service: 

1. The bureau has adopted dark gray as tHe standard color for 
service motor transportation, which color will be known as United 
States Public Health Service gray. Color cards will be furnished on 
application to the purveying depot. 

2. To insure uniformity of marking and to permit facility of 
identification and control all United States Public Health Service 
motor vehicles shall be painted in the United States Public Health 
Service gray standard color. The system of marking indicated 
below shall be observed. 

3. Motorized fire-fighting equipment will not be painted in the 
standard gray. Fire-fighting equipment, when requiring painting, 
shall be painted red. 

4. Numbers for motor vehicles have been assigned by the bureau. 
Such numbers preceded by letters " U. S. P. H. S." shall be stenciled 
on all vehicles, with the exception of motor cycles, in characters 2 
inches high, in conspicuous place inside the dash. For motorcycles i 



211 

the number assigned, preceded by letters " U. S. P. H. S.," shall be 
stenciled in characters 1 inch high on top the gasoline tank. 

5. All numbers shall be stenciled in white on black background. 

6. In addition to the painting and numbering indicated above, 
the following is prescribed : 

(a) Passenger vehicles with four doors shall have the serAn.ce seal 
(4-inch size) and the phrase " For Official Use Only " on the panel 
between the doors on both sides. Roadsters will have the above 
marking on both doors. (See drawing No. 1.) 

(h) Ambulances, other than Ford, shall have the service seal (8- 
inch size) and the phrase "U. S. Public Health Service Ambulance" 
on both sides. (See drawing No. 2.) 

(c) Ambulances, Ford, shall have the service seal (8-inch size) and 
the phrase " U. S. Public Health Service " on both sides. (See draw- 
ing No. 2.) 

(d) Trucks of less than 1-ton capacity shall be stenciled in black 
on both sides with the phrase " U. S. Public Health Service " in 
characters 2 inches high. (iSee drawing No. 3.) 

(e) Trucks of 1-ton capacity and over shall be stenciled in black 
on both sides of the tail gate with the phrase " U. S. Public Health 
Service" in characters 3 inches high. (See drawing No. 3.) 

(/) Motorcycles, also, shall have the service seal (4-inch size) on 
both sides of the gasoline tank. (See drawing No. 4.) 

(g) Motorcycles with side cars shall have the service seal (4-inch 
size,) on the left side of the gasoline tank and the right side of the 
side car. (See drawing No. 4.) 

7. Each motor truck cover will bear the same " U. S. P. H. S." 
number as the truck to which it belongs. This number shall be 
stenciled on both sides in the center ; bottom of symbols 24 inches 
from the hem of the cover in symbols 4 inches high. 

8. The service seals (4-inch and 8-inch sizes) and the lettering for 
touring cars and ambulances are made in transfer (decalcomania) 
and will be issued by the purveying depot on approved requisitions. 
Eequisitions for these transfers should indicate the number of each 
vehicle on hand for which they are required. 

9. The purveying depot will furnish United States Public Health 
Service gray in the following containers: 

United States Public Health Service gray ground in Japan (paste), 
1 and 5 pound cans. 

United States Public Health Service gray color varnish, 1 and 5 
gallon cans. 

United States Public Health Service pale rubbing varnish, 1 and 
5 gallon cans. 

United States Public Health Service gray paint mixed with oil, 
1 and 5 gallon cans and barrels. 



212 

10. Finishing varnish and paint brushes will be obtained from 
contractors as listed in general supply schedule under items No. 
8810-d-l and 8120, respectively. 

11. Medical officers in charge of stations will, in cases where prac- 
ticable, utilize station force for painting. When this is not feasible, 
an experienced painter will be nominated, for a stated period, to 
accomplish this work at the wage prevailing in the locality. 

12. When painting and marking of vehicles can not be done sat- 
isfactorily with the aid of the station force and a painter can not 
be employed, proposals for the performance of this work should be 
obtained by poster and circular-letter advertisement and forwarded 
to the bureau with definite recommendation relative to acceptance. 

13. So much of paragraph 1, bureau circular letter No. ITO, June 
6, 1919, as conflicts with this circular is hereby revoked. 

H. S. Gumming, 
Surgeon General. 



Necessity for Complying with Instructions Issued by Bureau and Field 

Stations. 

Treasurt Department, 
Bureau of the Public Health Service, 

Washington^ November 3, WBO. 

Bureau Circular Letter No. 237. 

To field officers of the Public Health Service: 

With the expansion of the field work of the service, it becomes 
increasingly necessary to place the organization of this work, includ- 
ing routine administration, on a sound footing. 

The bureau feels that it is possible to accomplish this only by a 
careful and strict compliance on the part of the field personnel with 
the instructions issued by the bureau and by the officers in charge of 
field activities. In other words, each officer should give the most 
careful attention to all requests from the bureau or field headquarters 
bearing on economy of expenditures for travel, preparation of official 
correspondence and reports, carrying out of service policy, and 
similar matters. 

In no other way will it be possible to coordinate sufficiently the 
work in the field with that of the bureau to assure at all. times a 
well- developed and smooth- running organization. 

J. C. Perry, 
Acting Surgeon General, 



213 

Instructions Relative to Forwarding to the Bureau Recommendations Which 

Are Retroactive. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington^ November 10^ 1920, 

Bnrean Circular Letter No. 238. 

To district supervisors^ medical officers in charge,, United States 

Marine and Public Health Service hospitals,, and others concerned: 

The bureau has noted the practice of field officers to request retro- 
active and blanket authority for travel, promotions, and other au- 
thorizations which necessitates explanations to the department. 

In many recent instances, requests for authorization for travel 
and for authority to issue cooked rations and for promotions have 
been retroactive several months. In other cases requests for authority 
have contained insufficient data upon which to make an intelligent 
request upon the department. 

In view of the above, all persons interested are hereby instructed 
that in the future no retroactive travel orders will be approved ex- 
cept in cases of urgent necessity or which are retroactive beyond a 
reasonable period. In no case will approval be given for orders 
retroactive for more than 10 days. Field officers can always obtain 
authority for travel by telegraph if necessary. Blanket travel orders 
will not be approved, except in very exceptional circumstances. 

Letters of nomination shall be so dated that when approved by the 
dej)artment they will not be effective retroactively beyond 10 days. 

Letters of promotion shall also be so dated that they shall not be 
retroactive, and shall fully set forth all data necessary so that an 
intelligent request may be made upon the department. They must 
give a detailed statement of the amount and character of work j)er- 
formed. Facts and figures must be given to substantiate the recom- 
mendation. 

In cases of requests for authority to issue cooked rations the re- 
quest must be made within 48 hours after the issue of rations has 
begun. The practice of requesting authoidty for the issue of cooked 
rations retroactive beyond 10 days will not be approved and medical 
officers in charge will be held financially responsible in such cases. 

Attention is again invited to Bureau Circular Letter No. 199, De- 
cember 27, 1919, in relation to retroactive requests for the congres- 
sional bonus. 

H. S. Gumming, 
Surgeon General. 



214 

Applications for Refundment of Salary Deductions in Accordance With 
Provisions of Civil Retirement Act, Approved May 22, 1920. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, Noveniber 18, 1920. 

Bureau Circular Letter No. 239. 

To all officers and employ ees concerned: 

The attention of all concerned is invited to the contents of section 
11, civil retirement act, approved May 22, 1920, which provides in 
part as follows : 

That in the case of an employee in the classified civil service of the United 
States who shall be transferred to an unclassified position, and in the case of 
any employee to whom this act applies who shall become absolutely separated 
from the service before becoming eligible for retirement on an annuity, the 
total amount of deductions of salary, pay, or compensation, with accrued in- 
terest computed at the rate of 4 per cent per annum, compounded on June 30 
of each fiscal year, shall upon application be returned to such employee. 

Classified employees separated from the service subsequent to July 
31, 1920, whose pay has been deducted under the provisions of the 
retirement act should execute in duplicate Bureau of Pensions Form 
3-R-6, together with Treasury Department Eeport on Application 
for Eefund, and transmit same to the bureau, the signature of the 
medical officer in charge to appear at the lower right-hand corner of 
the Treasury Department record in each case. After verification of 
data submitted in applications, Form 3-11-6 will be transmitted by 
the bureau to the Commissioner of Pensions for payment. 

Medical officers in charge of stations will be provided in the near 
future with a supply of the necessary blank forms sufficient to meet 
ordinary demands for a six months' period. 
Kespectfully, 

H. S. CUMMING, 

Surgeon General. 

Credit Allowed for Service in Army, Navy, Marine Corps, Coast Guard, and 
Coast and Geodetic Survey in Computing Longevity. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, November 18, 1920. 

Bureau Circular Letter No. 240. 

(Amending Bureau Circular Letter No. 213.) 

To officers of the Public Health Service: 

Bureau Circular Letter No. 213, dated April 5, 1920, contained an 
extrr ct from the act of Congress approved March 6, 1920, as follows : 

Officers of the Public Health Service shall be credited with service in the 
Army, Navy, Marine Corps, and Coast Guard in computing longevity pay. 



215 

The above quotation is hereby amended so as to include the United 
States Coast and Geodetic Survey, service in which may be counted 
toward longevity credit on an equal basis with other branches named. 
Those officers who claim service in the Coast and Geodetic Survey 
should support their claims with certified service records from the 
Director, United States Coast and Geodetic Survey. 
Respectfully, 

H. S. Gumming, 

Surgeon General. . 



Furnishing Copy of Form 1934-B to the Federal Board for Vocational 

Education. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, Noveinber 27, 1920. 

Bureau Circular Letter No. 241. 

To tnedical officers in charge, United States Marine and Public 
Health Service hospitals : 

In order to facilitate the placing of a patient about to be dis- 
charged from a hospital into training with the Federal Board for 
Vocational Education, you are requested to furnish a copy of Form 
1934^B of the final report of physical examination of such patient 
before his discharge to the educational director of the Federal Board 
for Vocational Education upon his request. 
Respectfully, 

H. S. Gumming, 
Surgeon General. 



Information Regarding the Importation of Live Snails and Other Mollusks. 

Treasury Department, 
Bureau or the Public Health Service, 

Washington, December 2, 1920. 

Bureau Circular Letter No. 242. 

To officers. United States Public Health Service: 

1. Information has reached the bureau that snails and possibly 
other mollusks are being imported into this country. 

2. As this subject has an exceedingly important bearing upon the 
possibility of the introduction and spread of exotic trematode dis- 
eases, the bureau is desirous of having immediate information as 
to the extent of this practice. 

3. Accordingly, the bureau requests that you will personally, or 
through detail of a member of your force, visit as soon as convenient 
the local retail and wholesale dealers in aquarium animals (fre- 
quently sold at bird stores) in order to obtain information, as com- 



216 

plete as feasible, on this subject. In case you find live snails in- 
troduced from foreign countries, the bureau would appreciate it if 
you could forward to the Division of Zoology, Hygienic Laboratory, 
Twenty-fifth and E streets northwest, Washington, D. C, a few 
specimens of each kind (alive, or preserved in alcohol or formalin) 
in order that these may be properly determined zoologically. In- 
formation as to origin (foreign country) should accompany the 
specimens. 

J. C. Perry, 
Acting Surgeon General. 



Distribution of Antirabic Vaccine. 

Treasury Department, 

BUREATJ OF THE PuBLIC PIeALTH SeRVIOE, 

Washington, December 9, 1920. 

Bureau Circular Letter No. 243. 

To State health o fleers and others concerned: 

1. The distribution of antirabic vaccine, which has been carried 
on by the Public Health Service through the Hygienic Laboratory, 
will be discontinued, effective January 1, 1921. 

2. This service was instituted in 1908 and has been furnished con- 
tinuously since that time. It has been a source of gratification to 
the Public Health Service to have been of assistance to State health 
organizations in this respect. It is now found necessary to discon- 
tinue the service owing to limitations of personnel and space. 

3. Requests for rabies vaccine will be honored up to and including 
January 1, 1921, and vaccine for completing all treatments begun 
under such requests will be supplied. 

4. The vaccine may be purchased from the following establish-' 
ments, now holding license issued by the Secretary of the Treasury: 

Parke, Davis & Co., Detroit, Mich. 

The Cutter Laboratory, Berkeley, Calif. 

Lederle Antitoxin Laboratories, Pearl River, N. Y, 

Eli Lilly & Co., Indianapolis, Ind. 

H. K. Mulford Co., Philadelphia, Pa. 

Bureau of Laboratories, Department of Health, New .York City. 

E. R. Squibb & Sons, New Brunswick, N. J. 

Gilliland Laboratories, Ambler, Pa. 

Dr. W. T. McDougall, Kansas City, Mo. 

Laboratory of Clinical Pathology, Kansas City, Mo. 

St. Louis Pasteur Institute, St. Louis, Mo. 

Dr. James McI. Phillips, Columbus, Ohio. 

Dr. D. L. Harris Laboratories, St. Louis, Mo. 

H. S. CUMMING, 

Surgeon General. 



217 

Examination of Employees Making Application for Reinstatement in the 
Department of Agriculture. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, December i^, lOW. 

Bnrean Circular Letter No. 244. 

To commissioned medical officers and acting assistant surgeons of the 

United /States Public Health Service : 

Medical officers of the United States Public Health Service vs^ill 
make examinations of employees of the Department of Agriculture 
who apply for reinstatement in that department. The number of 
such applicants will be limited, and upon applying for this examina- 
tion they must present papers from the Department of Agriculture 
showing that they are applicants for reinstatement. 

H. S. Gumming, 
Surgeon General. 



Revision of Instructions Relative to Forwarding to the Bureau Recommenda- 
tions Which are Retroactive. 

Treasury Department, 
Bureau of the Public Health Service, 

Washington, December 31, 1920. 

Bureau Circular Letter No. 245. 

(Amending Bureau Circular Letter No. 238.) 

To district supervisors, medical officers in charge, United States 
Marine and Public Health Service hospitals, and others concerned: 
Your attention is invited to Bureau Circular Letter No. 238, dated 
November 10, 1920, relative to retroactive authority for travel, pro- 
motions, and other authorizations. 

appointments. 

It is directed that in the future no recommendations for appoint- 
ment to any position be made, except those not within the competitive 
classified service, to become eifective prior to departmental approval. 
Time should be allowed for transmission of the request to the depart- 
ment through the bureau. 

The only exception tp this fixed rule will be emergency changes 
in personnel which are really of an emergency character, and each 
change of this nature must be fully explained to the bureau in trans- 
mitting recommendation for appointment of personnel. 

promotions. 

It is further directed that no recommendation for promotion or 
increased compensation, commutation of quarters, or subsistence 



218 

be made by fixing the date on wliich the promotion or other change 
will become effective prior to a date that will enable the bureau to 
forward the recommendation to the department and secure prior 
departmental approval. At stations where there is a special dis- 
bursing agent, increases in salaries which have not been approved 
by the bureau shall not be included on the rolls certified to by the 
commanding officer. No exceptions can he made to this -fixed rule. 

TRAVEL. 

Authorizations for travel must be prepared so that department ap- 
proval may be secured prior to the elate upon which the travel is 
to begin. The only exception to this rule will be strictly emergency 
cases, each one of which must be sustained by a detailed satisfactory 
explanation. 

Officers in charge of divisions of the bureau have been directed 
not to approve recommendations for appointment, promotion, or 
travel which do not comply with the above provisions. Bureau Cir- 
cular Letter No. 226, dated August 28, 1920, outlines the procedure 
to be followed by nomination officers in making recommendations 
for appointment to classified positions. Positions not listed in this 
circular letter are not included within the competitive classified 
service. You will iimnediately acknowledge receipt of this circular 
and state it has been received, is understood, and its provisions will 
be carried out. 

H. S. Gumming, 
Surgeon General. 



INDEX. 



[B. C. L.=Bureau Circular Letter.] 



A. 



B. 



Acting assistant dental sur 

geons, appointment of 

Acting assistant surgeons : 

Appointment of 

Nominations of 

Administrative assistants : 

Appointment of 

Classifications of B. 

Pay and allowances of B. 

Advertisements : 

Authorization of B. 

Length of time for B. 

Publication of B. 

Agriculture : 

Bureau of Animal In- 
dustry B. 

Examinations of employ- 
ees of B. 

Allegiance, oath of B. 

Allied nations, treatment fur- 
nished discharged soldiers 

of B. 

Almshouse, neuropsychiatric 
beneficiaries not to be con- 
fined in B. 

Aluminum ware, inspection of- B. 
Amosbic dysentery, treatment 

of B. 

Annual reports. (See Reports.) 

Anthrax B. 

Precautious against B. 

Appointments : 

Acting assistant dental sur- 
geons B. 

Acting assistant surgeons. B. 
Administrative assistants- B. 

Bacteriologists B. 

Chemists B. 

Civil-service rules govern- 
ing B. 

Consultants to marine hos- 
pitals B. 

Dietitians B. 

Nurses B. 

Reconstruction aides B. 

Retroactive B. 

X-ray technicians B. 

Appropriations, S u p e r v ising 
Architect's fund B. 



B. C. L. 22€ 



C. L. 226 
C. L. 66 



C. L. 
C. L. 
C. L. 



226 
229 
229 



C. L. 34 
C. L. 34 
C. L. 34 



C. L. 231 



C. L. 244 
C. L. 110 



C. L. 216 



C. L. 182 
C. L. 71 



C. L. 31 



C. L. 136 
C. L. 162 



C. L. 226 
C. L. 226 
C. L. 226 
C. L. 226 
C. L. 226 

C. L. 226 

C. L. 104 
C. L. 226 
C. L. 226 
C. L. 226 
C. L. 245 
C. L. 226 



C. L. 11 



Army : 

Admitting sick and 
wounded of, to quaran- 
linf ;jtatious and marine 
hospitals of Public 

Health Service B. C. L. 36 

Public Health Service hos- 
pitals open to sick and 

wounded of B. C. 

Supplies issued by B. C. 

Arsenic, use of preparations of, 

in treatment of syphilis B. C. 

Arsephenamiue : 

Administration of B. C. 

Clinical results observed in 

using B. C 

Reports of clinical results 

observed in use of B. C. 

Articles which harbor rats, 

disinfection of B. C. 

Association of Military Sur- 
geons : 

Advantages of joining B. C. 

Officers of B. C. 

Automobiles. (See Motor vehicles.) 



L. 109 
L. 158 

L. 219 

L. 163 

L. 153 

L. 121 

L. 39 



L. 210 
L. 210 



B. 

Bacteriologists, a p p o 1 ntment 
of 

Bar pilots, right of relief of, as 
patients of the U. S. Public 

Health Service 

Beaumont, Tex., U. S. Plague 
Laboratory, shipment of 

plague-infected material to 

Bedding, disinfection of 

Beneficiaries : 

Admission of war-risk in- 
surance beneficiaries to 
Public Health Service 

hospitals 

Bar pilots 

Coast Guard 

Examination of, by the 

Public Health Service 

Fees for professional serv- 
ices to 

Fishermen 

Lighthouse Service 

Mental neuropsychiatric 



B. C. L. 226 



— B. C. L. 46 



B. C. L. 227 
B. C. L. 39 



B. C. L. 159 
B. C. L. 46 
B. C. L. 70 

B. C. L. 184 

B. C. L. 107 
B. C. L. 46 
B. C. L. 57 
B. C. L. 182 



(219) 



220 



Beneficiaries — Continued. 

Treatment furnished dis- 
charged soldiers of the 

allied nations B. C. L. 216 

Treatment of, war risk in- 
surance B. C. L. 150 

Treatment of, by Red 

Cross B. C. L. 166 

Bills : 

Chargeable to Supervising 

Architect's fund B. C. L. 11 

Itemizing of B. C. L. 34 

Birth registration B. C. L. 125 

Blanks, requisitions for_ B. C. L. 13, 54, 234 
Books : 

Inspection of B. C. L. 71 

Requisitions for B. C. L. 54 

Bonus : 

Instruction of, for discon- 
tinuing for part-time 

employees B. C. L. 205 

Instructions relative to 

recommendation for B. C. L. 199 

Brushes, shaving : 

Infection of B. C. L. 136, 162 

Shipment of B. C. L. 136, 162 

Sterilization of B. C. L. 136, 162 

Bubonic plague, shipment of 
tissue of persons for ani- 
mals suspected of suffering 

from B. C. L. 227 

Buildings, repairs and new 

construction of B. C. L. 35 

Bureau : 

Form of reports to B. C. L. 47 

Instructions issued by B. C. L. 287 

Record of personnel B. C. L. 178 

Bureau of Animal Industry, 

establishments inspected by B. C. L. 231 

Bureau of Laboratories B. C. L. 248 

Butter, use of substitutes for, 

in hospitals of the service B. C. L. 186 

C. 

Canadian soldiers : 

Instructions relative to 

treatment of B. C. L. 208 

Treatment of discharged B. C. L. 201 

Treatment of, in hospitals 

of the service B. C. L. 185 

Cards, standardization of, at 
field stations in accordance 
with sizes adopted in Wash- 
ington B. C. L. 48 

Card A. report of examination 

and disposition of patient B. C. L. 168 

Card B, case record B. C. L. 168 

Card C, record of discharge 

from hospital B. C. L. 168 

Card D. hospital admission 

card B. C. L. 168 

Cargo, fumigation of nondisin- 

fectable B. C. L. 39 

Carpets, inspection of B. C. L. 71 

Cars, inspection of sanitary 

conditions of B. C. L. 84 

Chemists, appointment of B. C. L. 226 



Child-welfare activities, coop- 
eration of service in B. C. L. 125 

Civil employees, compensation 

for injured employees B. C. L. 115 

Civil retirement act B. C. L. 289 

Civil service, rules relating to 

appointment of employees B. C. L. 69 

Civil-service districts, list of__ B. C. L. 226 
Civil-service rules, classified 

positions under B. C. L. 226 

Circulars, distribution of, to 

field stations B. C. L. 175 

Clothes, disinfection of B. C. L. 39 

Coast Guard : 

Clinical histories of Coast 
Guard patients in serv- 
ice hospitals B. C. L. 87 

Discharge of members of 
undergoing treatment at 
first or second-class 
stations of the service. B. C. L. 77 
Discontinuing clinical his- 
tories of patients of B. C. L. 131 

Right of medical treat- 
ment by officers and en- 
listed men of B. C. L. 70 

Code: 

Service telegraphic code B. C. L. 82 

Telegraphic, suggestions 

relative to use of B. C. L. 32 

Commissioned medical officers, 

status of B. C. L. 139 

Communicable diseases : 

Handling of food and 
dishes by patients suf- 
fering with B. C. L. 180 

Reporting prevalence of B. C. L. 119 

(See Diseases.) 
Commissary privileges, grant- 
ing of, to officers of the Pub- 
lic Health Service B. C. L. 211-222 

Commutation : 

Heat and light B. C. L. 141 

Increase in B. C. L. 220 

Commutation of quarters : 

Discontinuance of pay 

voucher for B. C. L. 78 

Income tax for B. C. L. 106 

Officers on temporary duty_ B. C. L. 90 
Compensation : 

Additional, at the rate of 

$1,200 per annum B. C. L. 134 

Additional, at the rate of 

$240 per annum B. C. L. 176 

Additional, form of cer- 
tificate to procure B. C. L. 137 

Base pay for appointees B. C. L. 177 

Five and ten per cent in- 
crease of B. C. L. 116 

Consultants : 

Appointment of B. C. L. 104 

Marine hospitals B. C. L. 104 

Contracts : 

Competition in making B. C. L. 34 

Information and instruc- 
tions relative to{ B. C. L. 34 



221 



Contracts — Continued. 

Meat, preference given to 
Government-i nspected 

establishments B. C. L. 231 

Cream, use of substitute for, 

in hospitals of the service B. C. L. 186 

Cumulative tables, use made of 

in public health work B. C. L. 24 

Currio, Surg. Donald Herbert, 

obituary notice of B. C. L. 156 

Cutter Laboratory B. C. L. 243 

D. 

Depots, sanitary conditions of B. C. L. 84 

Dermatological Research Lab- 
oratories B. C. L. 219 

Diarsenol Co B. C. L. 219 

Dietitians : 

Appointment of B. C. L. 226 

Duties B. C. L. 173 

Equipment B. C. L. 173 

Relation of, to hospital staff- B. C. L. 173 
Reporting dates of arrival 

and departure B. C. L. 233 

Status B. C. L. 173 

Diseases, communicable (pre- 
venting spread of) B. C. L. 1 

Diseases : 

Amoebic dysentery B. C. L. 31 

Anthrax B. C. L. 136, 162 

Communicable, use of cumu- 
lative tables in report- 
ing B. C. L. 24 

Enteric fever, reporting 

patients suffering V7ith_ B. C. L. 17 

Influenza B. C. L. 142, 143 

Malaria B. C. L. 9, 128, 133 

^ Mental B. C. L. 202 

Reporting prevalence of_ B. C. L. 29, 37 

Tuberculosis B. C. L. 4 

Discipline : Civilian rather than 
military to be maintained at 

hospitals of the service B. C. L. 171 

Disinfection : 

Articles that harbor rats_ B. C. L. 39 

Certificate of B. C. L. 39 

Method of disinfecting ves- 
sel B. C. L. 4 

Districts : 

Civil service B. C. L. 226 

Organization of for relief 
to service beneficiaries 

of all classes B. C. L. 168 

Reports of activities In — B. C. L. 168 
District supervisors : 

In charge of third and 

fourth class stations B. C. L. 214 

Inspection of State hospi- 
tals by B. C. L. 182 

Draft • 

Age limit B. C. L. 140 

Deferred classification of 

oflacers and employees-- B. C. L. 144 
Drags : 

Heroin B. C. L. 102 

Narcotic B. C. L. 89 



E. 

Efficiency: 

Confidential reports of B. C. L. 203 

Promotion of B. C. L. 83 

Eggs, certification of B. C. L. 39 

Electric current, preparation of 

vouchers B. C. L. P7 

Eli Lilly and Co B. C. L. 243 

Emetine hydrochloride, use of 
in treatment of amoebic dys- 
entery . B. C. L. 31 

Employees : 

Classification of field serv- 
ice B. C. L. 22.5 

Classification of in accord- 
ance with provisions of 
retirement act approved 

May 22, 1920 B. C. L. 224 

Promotion under probation B. C. L. 56 
Employees Compensation Com- 
mission : 

Admission reports B. C. L. 192 

Clinical histories of in- 
jured employees B. C. L. 127 

Discharged reports B. C. L. 192 

Employees compensation 

fund B. C. L. 114 

Examination of civil em- 
ployees injured in per- 
formance of their duties B. C. L. 114 

Jurisdiction of B. C. L. 115 

Reports of relief for 

B. C. L. 148, 192, 197 
Enteric fever, reporting pa- 
tients suffering with B. C. L. a7 

Epidemics, reporting of- B. C. L. 29, 37, 119 
Equipment : 

Hospital B. C. L. 21 

Purchase of tools B. C. L. 3 

Estimates : 

Forwarding of B. C. L. 35 

Hospital equipment B. C. L. 21 

Repairs and new construc- 
tion of buildings B. C. L. 35 

European War : 

Draft B. C. L. 144 

Public Health Service 

part of B. C. L. 109 

Examinations : 

Bacteriological B. C. L. 227 

Cases for Federal board B. C. L. 179 

Coast Guard B. C. L. 75 

Foreign seamen B. C. L. 94 

Merchant marine B. C. L. 95 

Physical B. C. L. 74 

Record of patients and 

disposition of patients B. C. L. 168 

Expendable property. (See 

Property.) 
Expenditures : 

Economy in B. C. L. 2 

Relief of patients of War 

Risk Insurance Bureau- B. C. L. 174 



222 



p. 

Federal Board for Vocational 
Education : 

Examination of cases for_ B. C. L. 179 
Examination of disabled 

men for B. C. L. 149 

Training of disabled men 

by B. C. L. 188 

Treatment of disabled men 
while undergoing train- 
ing by B. C. L. 188 

Federal compensation act, reg- 
ulations concerning B. C. L. 135 

Field duty, addresses of offi- 
cers on B. C. L. 122 

Field service, classification of 

employees of B. d. L. 225 

Field stations, compliance with 

instructions issued by B. C. L. 237 

Filing equipment, standardiza- 
tion of at field stations in 
accordance with sizes 

adopted in Washington B. C. L. 48 

Fishermen, right of relief of 
as patients of +he U. S. 

Public Health Service B. C. L. 46 

Food products, disinfection of- B. C. L. 39 
Foreign seamen : 

Care of B. C. L. 30 

Fees for examination of B. C. L. 98 

Fort Stanton, records of pa- 
tients recommended for 

transfer to B. C. L. 45 

Freight : 

Certification of B. C. L. 39 

Certification of from chol- 
era-infected ports B. C. L. 39 

Certification of from for- 
eign ports B. C. L. 39 

Certification of from local- 
ities intected with 

plague B. C. L. 39 

Disinfection of B. C. L. 39 

Treatment of B. C. L. 39 

Fumigation : 

Hydrocyanic gas B. C. L. 100 

Provisional standard for, 

with hydrocyanic gas — B. C. L. 79 
Furniture : 

Disinfection of B. C. L. 39 

Inspection of B. C. L. 71 

G. 

Galveston, Tex. U. S. Plague 

Laboratory, shipment of 

plague-infected material to B. C. L. 227 

Gas, preparation of vouchers 

for B. C. L. 67 

Gasoline, purchase of B. C. L. 161 

General hospitals : 

Inspection of ^ B. C. L. 182 

Psychopathic wards B. C. L. 182 

Gillllanfl Laboratories B. C. L. 243 

Governmeat telephones, use of- B. C. L. 91 



Government employees, rates 
charged for care of, in con- 
tract hospitals of the service- B. C. L. 115 

Government reservations, regis- 
tration of births and deaths 
on B. C. L. 43 

H. 

Harris Laboratories B. C. L. 243 

Health education by means of 

newspaper articles B. C. L. 165 

Heat, commutation for B. C. L. 141, 220 

Heroin, discontinuance of the 

use of—'- B. C. L. 102 

Hides, certification of B. C. L. 39 

Hospital accommodations : 

Care of communicable dis- 
eases B. C. L. 182 

Heat B. C. L. 182 

Lighting B. ('. L. 182 

Space B. C. L. 182 

Hospitals. (See Hospitals of 

the service.) 
Hospitals of the service : 

Admission to hospital 
treatment at second, 
third, and fourth class 

stations B. C. L. 19 

Base pay for appointees 

in B. C. L. 177 

Discipline to be main- 
tained at B. C. L. 171 

Distribution of circulars 

to B. C. L. 175 

Epiletic patients. East 

Norfolk, Mass B. C. L. 182 

Estimates for equipment-- B. C. L. 21 

Insane, Dansville, N. T B. C. L. 182 

Inspection of B. C. L. 171 

Monthly reports of pa- 
tients admitted and dis- 
charges from B. C. L. 14 

Open to sick and wounded 

of Army and Navy B. C. L. 109 

Psychoneurotic patients, 

Waukesha, Wis B. C. L. 182 

Rules for visitors at B. C. L. 171 

Treatment of discharged 

Canadian soldiers in B. C. L. 185 

Use of substitutes for but- 
ter and cream in B. C. L. 186 

Hydrocyanic-acid gas : 

Fumigation with B. C. L. 100 

Provisional standard for 

fumigation with B. C. L. 79 

Safeguards to be observed 

in fumigation with B. C. L. 129 

Hygienic Laboratory : 

Discontinuance of distribu- 
tion of antirabic vac- 
cine by B. C. L. 243 

Distribution of antity- 
phoid vaccine by B. C. L. 12 

Shipment of plague-in- 
fected material to B. C. L. 227 

Transmission of patholog- 
ical specimens to B. C. L. 53 



223 



I. 

Improvement, committee of B. C. L. S3 

Income tax : 

Claims for exemption from_ B. C. L. 50 

For value of quarters B. C. L. 106 

Infant care B. C. L. 125 

Influenza, poster for preven- 
tion of B. C. L. 142, 143 

Insane, State hospitals for the_ B. C. L. 182 
Insane patients : 

Clinical history of B. C. L. 182 

Committing of, to Dans- 

ville B. C. L. 182 

Committing of, to State 

hospitals B. C. L. 182 

• Cost of committing to 

State hospitals B. C. L. 182 

Jurisdiction of Public 
Health Service over neu- 
ropsychiatric patients 
who may have been 

placed in prisons B. C. L. 182 

Sworn statement of insan- 
ity B. C. L. 182 

Transportation B. C. L. 182 

Inspection : 

Aluminum ware B. C. J. 71 

Yearly, of quarantine sta- 
tions and marine hos- 
pitals B. C. L. 35 

Interstate passengers, sanitary 
conditions of cars, vessels, 
etc., maintained for the use 
of B. C. L. 84 

J. 

Jails, neuropsychiatric bene- 
ficiaries not to be confined 
in B. C. L. 182 

Joint Committee on Printing. B. C. L. 190 

li. 

Laboratory of Clinical Pa- 
thology B. C. L. 243 

Laws, State and local health 

laws B. C. L. 63 

Leaves of absence granted un- 
der the authority of the reg- 
ulations . B. C. L. 93 

Lederle Antitoxin Labora- 
tories B. C. L. 243 

Light, commutation B. C. L. 141, 220 

Lighthouse Service : 

Issuance of bills for care 
and treatment of certain 

employees of B. C. L. 68 

Medical relief for light 
keepers and assistant 

keepers B. C. L. 96 

Treatment of officers and 

employees of B. C. L. 57 

Longevity pay, credit allowed 
for service in the Army 

or Navy B. C. L. 213, 240 

Lowry Laboratory B. C. L. 219 



M. 

Maintenance of marine hos- 
pitals, necessity for economy 
in the expenditures charge- 
able to the appropriation B. C. L. 2 

Malaria : 

Poster for prevention of 

B. C. L. 128, 133 

Prevention of B. C. L. 9 

Marine hospitals : 

Admission to, of persons 
rejected for military 
service on account of 

curable conditions B. C. L. 120 

Available for care of sick 
and wounded of the 

Army and Navy B. C. L. 36 

Consultants appointed to_ B. C. L. 104 
Money needed for re- 
mainder of fiscal year 

1914 B. C. L. 22 

Kate of charge for soldiers 

and seamen admitted to_ B. C. L, 38 
Mattresses, hair and cotton, 

inspection of B. C. L. 71 

Meal requests : 

Countersigning of B. C. L. 200 

Instructions concerning B. C. L. 196 

Meat, supplying Public Health 

Service stations with B. C. L. 231 

Medical Journal, regulations 

governing publication in B. C. L. 191 

Medical supplies, transmission 

of requisitions for B. C. L. 23, 27 

Medicines : 

Authority to be cited on 
bills for medicines fur- 
nished by apothecaries- B. C. L. 26 
Emergency purchases of- B. C. L. 73 
Reimbursement for cost of, 
in care of foreign sea- 
men B. C. L. 30 

Mental clinics, capacity of 

State hospitals for B. C. L. 182 

Mental diseases, classification 

of B. C. L. 202 

Merchant marine : 

Physical examination of 

recruits for B. C. L. 155 

Reexamination of officers 

and men of B. C. L. 95 

Metz Laboratories B. C. L. 219 

Milk, safe and sufficient milk 

supply B. C. L. 125 

Military forces : 

Public Health Service In- 
cluded in B. C. L. 139 

Public Health Service part 

of B. C. L. 109 

Military Surgeons, Association 

of B. C. L. 210 

Mollusks, importation of B. C. L. 242 

Monthly statement of expendi- 
tures and liabilities, freight 
and express charges to be in- 
cluded in B. C. L. 5 



224 



Morbidity reports. {See Re- 
ports.) 
Motor vehicles : 

Ambulances B. C. L. 236 

Care of in freezing temper- 
ature B. C. L. 189 

Instructions for procuring 

tires and tubes for B. C. L. 193 

Lettering of for official 

business only B. C. L. 170 

Marking of B. C. L. 236 

Method of procuring acces- 
sories for B. C. L. 206 

Motorcycles B. C. L. 236 

Purchases of acces- 
sories for B. C. L. 161 

Purchases of accessories 

for B. C. L. 169 

Purchases of spare parts 

for B. C. L. 228 

Repair of B. C. L. 161, 169 

Service seals, standard 
color for Public Health 

Service 

Trucks, use for official 

business only B. C. L. 170 

Mulford Co., H. K B. C. L. 243 

N. 

Narcotic drugs, handling of by 
employees of Government 

agencies B. C. L. 89 

Narcotic supplies for lighthouse 

vessels B. C. L. 60 

Navy : 

Admitting sick and vround- 
ed of to quarantine sta- 
tions and marine hos- 
pitals of the Public 

Health Service B. C. L. 36 

Public Health Service hos- 
pitals open to sick and 

wounded of B. C. L. 109 

Neoarsphenamine : 

Administration of B. C. L. 163 

Clinical results observed 

in using B. C. L. 153 

Neoslavarsan : 

Purchase of B. C. L. 16 

Requisitions for B. C. L. 18 

New Orleans, La., U. S. Plague 
Laboratory, shipment of 
plague-infected material to — B. C. L. 227 
Neuro-psychiatry : 

Appointment of examiners 

in B. C. L. 182 

Fees for examinations B. C. L. 182 

Special examiners in B. C. L. 182 

Newspapers, health education 

by articles in B. C. L. 165 

Nomenclature of diseases and 

conditions, additions to B. C. L. 198 

Nomenclature of mental dis- 
eases B. C.L.202 

Nonexpendable property B. C. L. 42 

Nominations, retroactive au- 
thority for B. C. L. 238 



Nurses : 

Appointment of B. C. L. 226 

Reporting dates of arrival 

and departure B. C. L. 233 

Nomination and appoint- 
ment of B. C. L. 172 

Rules governing at hos- 
pitals B. C. L. 171 

Nutrition, care of child during 
preschool age B. C. L. 125 

O. 

Offlciers, designation of, in 

charge of stations B. C. L. 8 

Oil, purchase of B. C. L. 161 

P. 

Parke, Davis & Co B. C. L. 243 

Pathological specimens, trans- 
mission of, to Hygienic Labo- 
ratory B. C. L. 53 

Patients : 

Army B. C. L. 138 

Clinical histories of B. C. L. 87 

Clinical records of B. C. L. 45 

Handling of food by B. C. L. 180 

Insane. (See Insane patients.) 

Insane, committing of to 
State hospitals B. C. L. 182 ' 

Mental, treatment of B. C. L. 181 

Monthly reports of patients 
admitted and discharged 
from hospitals B. C. L. 14 

Navy B. C. L. 131, 138 

Neuropsychiatric B. C. L. 181 

Relief of war-risk insur- 
ance patients B. C. L. 174 

Responsibility for money 

and other valuables of B, C. L. 99 

Transfer of, to marine 

hospitals B. C. L. 59 

War-risk insurance __ B. C. L. 126, 138 
Pay: 

Administrative assistants- B. C. L. 226 

Increase in, for officers B. C. L. 220 

Longevity B. C. L. 213, 240 

Pay rolls : 

Forms for retirement de- 
ductions B. C. L. 225 

For increase of pay B. C. L. 220 

New form of pay and com- 
mutation roll B. C. L. 88 

Preparation of B. C. L. 20 

Preparation of, in accord- 
ance with provisions of 
retirement act approved 
May 22, 1920 B. C. L. 224 

Preparation of, under pro- 
visions of act of May , 

18, 1920 B. C. L. 223 

Penalty envelopes and labels, 

the use of B. C. L. 64 

Pensacola, Fla., TJ. S. Plague 
Laboratory, s h i p m e nt of 
plague-infected material to — B. C. L. 227 



225 



Personnel t 

Acting assistant surgeons_ B. C. L. 66 

Acting assistant surgeons, 
submitting data relating 
to B. C. L. 199 

Amendment to civil-service 
rules relating to the ap- 
pointment of employees. B. C. L. 69 

Administrative assistants- B. C. L. 229 

Changes in, reporting B. C. L. 15 

Communications originat- 
ing with subordinate 
personnel B. C. L. 218 

Confidential efficiency re- 
ports B. C. L. 203 

Dietitians B. C. L. 173 

Information relative to B. C. L. 230 

Nurses B. C. L. 172 

Personnel Form No. 3, in- 
structions for submitting B. C. L. 199 

Reconstruction. (See Re- 
construction personnel.) 

Record of, for bureau B. C. L. 178 

Reporting changes in— B. C. L. 93, 199 

Scientific assistants B. C. L. 69 

Pharmacists, articles of sub- 
sistence drawn by B. C. L. 101 

Physical examinations : 

Able seamen B. C. L. 74, 80 

Coast Guard B. C. L. 75, 167 

Disabled men for Federal 
Board for Vocational 
Education B. C. L. 149 

Discharged Canadian sol- 
diers B. C. L. 185 

Employees of the Depart- 
ment of Agriculture B. C. L. 244 

Federal Board for Voca- 
tional Education B. C. L. 241 

For Government positions 

as unskilled laborers B. C. L. 86 

For persons who enroll in 
the navigation and engi- 
neering schools to be es- 
tablished by the U. S. 
Shipping Board B. C. L. 117, 118 

Foreign seamen B. C. L. 94 

Merchant marine B. C. L. 95 

Persons who have been re- 
jected for military serv- 
ice on account of cura- 
ble conditions B. C. L. 120 

Recording B. C. L. 76 

Recruits for merchant ma- 
rine B. C. L. 155 

plague : 

Human cases B. C. L. 227 

Rodent cases B. C. L. 227 

Shipment of tissue of per- 
sons for animals sus- 
pected of suffering from B. C. L. 227 
Post Office Department, use of 

penalty envelopes and labels- B. C. L. 64 
Printing : 

Classes of, not to be done 
in Government Printing 
Office B. C. L. 190 

14330°— 21 15 



Printing — Continued. 

Emergency B. C. L. 190 

For field work B. C. L. 190 

Prisons, neuropsychiatric bene- 
ficiaries not to be confined 
in B. C. L. 182 

Promotions : 

Promotions under proba- 
tion B. C. L. 56 

Retroactive B. C. L. 238, 243 

Property : 

Expendable B. C. L. 41 

Inspection of unservice- 
able property B. C. L. 71 

List of expendable prop- 
erty B. C. L. 72 

Nonexpendable B. C. L. 42 

Proposals : 

Chargeable to Supervising 

Architect's fund B. C. L. 11 

Information and instruc- 
tions relative to B. C. D. 34 

Specifications for B. C. L. 34 

Public buildings, instructions 

to custodians of B. C. L. 105 

Public health reports, cumu- 
lative tables in B. C. L. 24 

Public Health Service : 

Granting of commissary 

privileges to officers of B. C. L. 211 

Included in military and , 

naval service of the 

United States B. C. L. 139 

Military status of per- 
sonnel of B. C. L. 154 

Purchases : 

Exigency B. C. L. 25, 34 

Emergency, of medicine B. C. L. 73 

Instructions for B. C. L. 34 

Tires and tubes for motor 

vehicles B. C. L. 193 

Purveying depot : 

Requisitions for antityphoid 

vaccine to be sent to B. C. L. 61 

Requisitions for neosalvar- 

san to be sent to B. C. L. 18 

Requisitions for replace- 
ment parts to be sent to_ B. C. L. 228 
Stock of heroin to be sent 

to B. C. L. 102 

Supplies received from B. C. L. 103 

Q. 

Quarantine stations available 

for care of sick and wounded 

of the Army and Navy B. C. L. 36 

Quarters, commutation 

of B. C. L. 78, 90, 106 

R. 
Rags : 

Disinfection of B. C. L. 39 

Fumigation of B. C. L. 39 

Rations, retroactive authority 

for B. C. L. 238 

Rats, articles which harbor B. C. L. 39 



226 



Reconstruction aides : 

Appointment of B. C. L. 226 

Reporting dates of arrival 

and departure B. C. L. 233 

Reconstruction personnel : 

Occupational therapy B. C. L. 183 

Pay of B. C. L. 183 

Physiotherapy aides B. C. L. 183 

Reconstruction aides B. C. L. 183 

Reconstruction officers B. C. L. 183 

Records : 

Card A, card B, card C— B. C. L. 168 
Clinical, in State hospitals- B. C. L. 182 
Red Cross, cooperation with by 
officials of the Public Health 

Service B. C. L. 166 

Registration : 

Age for draft—— B. C. L. 140 

Births and deaths on Gov- 
ernment reservations B. C. L. 43 

Regulations : 

Reporting leaves of ab- 
sence B. C. L. 93 

Reporting changes in per- 
sonnel B. C. L. 93 

Service, revision of B. C. L. 160 

Service, transmitting 

amendments to B. C. L. 28 

Transmitting copy of serv- 
ice B. C. L. 10 

Uniform, revision of B. C. L. 6 

Relief : 

I/ight keepers and assist- 
ant light keepers B. C. L. 96 

Medical B. C. L. 96 

Merchant seamen B. C. L. 4 

Reports : 

Annual B. C. L. 40 

Annual reports of activi- 
ties in districts B. C. L. 168 

Annual, transmission of — B. C. L. 92 

Confidential efficiency B. C. L. 203 

Form of reports to bureau- B. C. L. 47 

Monthly, of patients B. C. L. 14 

Monthly reports of activi- 
ties in districts B. C. L. 168 

Morbidity, transmission of _ B. C. L. 29 

Relief B. C. L. 49, 197 

Weekly reports of activi- 
ties in districts B. C. L. 168 

Reserve Corps : 

Instructions concerning 

signature of officers in_ B. C. L. 209 

Signature of officers in B. C. L. 164 

Status of officers in B. C. L. 221 

Information for applicants 
for appointment and com- 
mission in B. C. L. 151 

Organization of B. C. L. 152 

Physicians B. C. L. 151 

Recommending candidates 

for B. C. L. 152 

Sanitarians B. C. L. 151 

Scientists B. C. L. 151 

Retirement act B. C. L. 224, 230 



Revenue-Cutter Service : 

Clinical reports of sick 
officers at marine hos- 
pitals B. C. L. 52 

Treatment of officers and 
seamen of, for venereal 

diseases during 1913 B. C. L. 33 

Rubber goods (including hose), 

inspection of B. C. L. 71 

S. 

St. Louis Pasteur Institute B. C. L. 243 

Salary deductions, amendment 

of B. C. L. 289 

San Francisco, Calif., U. S. 
Plague Laboratory, shipment 
of plague-infected .material 
to B. C. L. 227 

Sanitariums : 

Private B. C. L. 182 

Sending of neuropsychia- 

tric beneficiaries to B. C. L. 182 

Seamen : 

Definition of, in relation 

to treatment B. C. L. 46 

Foreign B. C. L. 30 

Rate of charge for admis- 
sion to marine hos- 
pitals B. C. L. 38 

Report of condition of B. C. L. 19 

Service exhibit : 

Activities of the Public 

Health Service B. C. L. 212 

Rehabilitation of disabled 

soldiers B. C. L. 212 

Service regulations. (See Reg- 
ulations.) 
Service relief stations, admis- 
sion of war-risk insurance 

beneficiaries to B. C. L. 159 

Schedule of supplies. (See 

Supplies.) 
Selective-service regulations. 
Public Health Service in- 
cluded in B. C. L. 139 

Service work, suggestions for 

improvement of B. C. L. 83 

Shipping Board, physical exam- 
inations for persons in Navi- 
gation and Engineering 

Schools of B. C. L. 117, 118 

Snails, information regarding 

importation of B. C, L. 242 

Social service, work in State 

hospitals B. C. L. 182 

Soldiers, rate of charge for ad- 
mission to marine hospitals- B. C. L. 38 

Squibb & Sons, B. R B. C. L. 243 

State health laws : 

Compliance with, by offi- 
cers of the Public 

Health Service B. C. L. 63, 123 

Compliance with B. C. L. 145 

State hospitals : 

Clinical records B. C. L. 182 

Diet B. C. L. 182 



227 



state hospitals — Continued. 

Hospital accommodations- B. C. L. 182 
Insane B. C. L. 182 

Inspection of, by district 

supervisors B. C. L. 182 

Laboratory department B. C. L. 182 

Mental clinics B. C. L. 182 

Nursing department B. C. L. 182 

Social-service branch B. C. L. 182 

Vocational therapy B. C. L. 182 

Stationery : 

Invoices B. C L. 235 

Requisitions for_ B. C. L. 13, 34, 55, 234 
Subsistence, record of articles of, 

cers in charge of B. C. L. 8 

Subsistence, record of articles 

of, drawn by pharmacists — B. C. L. 101 
Sulphur gas, use in fumigation 

of B. C. L. 39 

Sundry civil act, increase of 

compensation approved by — B. C. L. 116 
Supervising Architect : 

Appropriation under con- 
trol of B. C. L. 11 

Funds under supervision 

of B. C. L. Ill 

Local representative of B. C. L. Ill 

Proposals for office of B. C. L. 105 

Supplies : 

Fire hose, testing of B. C. L. 132 

Inferior supplies from pur- 
veying depot B. C. L. 103 

Medical, requisitions for B. C. L. 23 

Narcotic, for lighthouse 

vessels B. C. L. 60 

Purchase of tools '. B. C. L. 3 

Purchases and contracts 

for B. C. L. 34 

Transfer of by the Secre- 
tary of War to the Sec- 
retary of the Treasury 
for use in Public Health 

Service hospitals B. C. L. 158 

Schedule of B. C. L. 34 

To be paid out of funds 
under the control of 

Supervising Architect B. C. L. Ill 

Surgical instruments, inspec- 
tion of B. C. L. 71 

Syphilis, use of arsenic prepa- 
rations in treatment of B. C. L. 219 

T. 

Takamine Laboratories B. C. L. 219 

Telegrams : 

Brevity B. C. L. 232 

Dates B. C. L. 232 

Leaves of absence B. C. L. 232 

Night messages B. C. L. 232 

Official business B. C. L. 232 

Rates B. C. L. 232 

Rules governing B. C. L. 232 

Rules governing tele- 
graphic messages B. C. L. 81 

Signing B. C. L. 232 

Telegraphic code B. C. L. 82 

Use of telegraphic code B. C. L. 33 



Telephones, use of Government- B. C. L. 91 
Temporary duty, allowance of 

officers on B. C. L. 90 

Textile fabrics, disinfection of- B. C. L. 39 

Tools, purchase of B. C. L. 3 

Transportation : 

Blanket authority for B. C. L. 238 

Families B. C. L. 220 

Express B. C. L. 5 

Freight B. C. L. 5 

Preparation of vouchers 
for reimbursement of 

travel expenses B. C. L. 85 

Retroactive B. C. L. 238, 245 

Vouchers for B. C. L. 44 

Transportation requests, coun- 
tersigning of B. C. L. 196, 200, 204 

Divisions of the bureau to 

be indicated thereon B. C. L. 195 

Filling in block spaces of_ B. C. L. 112 
Instructions concerning use 

of B. C. L. 146 

Issuing of B. C. L. 196 

Special instructions for 

use of B. C. L. 58 

Use of B. C. L. 58 

War risk B. C. L. 217 

Treasury Department, commu- 
nications to to be transmit- 
ted through the bureau B. C. L. 97 

Tuberculosis, prevention of 
spread of among merchant 

seamen B. C. L. 4 

Typewriters, inspection of B. C. L. 71 

Typhoid : 

Administration of typhoid 

vaccine B. C. L. 61 

Antityphoid vaccine B. C. L. 12 

Inoculation against B. C. L. 80 

Typhoid and paratyphoid 

vaccines B. C. L. 124 

Vaccination against B. C. L. 62, 113 



U. 

Uniform regulations 

(See Regulations.) 



— B. C. L. 6 



V. 

Vaccination : 

Antityphoid B. C. L. 12 

Antityphoid, administra- 
tion of B. C. L. 61 

Arsephenamine B. C. L. 121, 153, 163 

Distribution of antirabic 

vaccine B. C. L. 243 

Distribution of typhoid 
and paratyphoid vac- 
cine B. C. L. 124 

Neoarsphenamine B. C. L. 153, 163 

Neosalvarsan B. C. L. 16 

Ships' crews B. C. L. 108 

Smallpox B. C. L. 80 

Typhoid B. C. L. 62 

Venereal diseases : 

Discharge of beneficiaries 

suffering with B. C. L. 130 



228 



Venereal disease — Continued. 

Information on venereal 

infection B. C. L. 207 

Manual of treatment for B. C. L. 145 

Number of persons suffer- 
ing from B. C. L. 207 

Treatment of Revenue-Cut- 
ter Service officers and 
seamen for B. C. L. 33 

SypWllis B. C. L. 219 

Venereal diseases, division of, 

letters from the field to B. C. L. 147 

Vessels : 

Lighthouse, narcotic sup- 
plies for B. C. L. 60 

Sanitary conditions of B. C. L. 84 

Vocational therapy, use in 

State hospitals B. C. L. 182 

Vouchers : 

Army patients B. C. L. 188 

Completion of B. C. L. 51 

Exigency purchases B. C. L. 34 

For hospital treatment B. C. L. 168 

Information and instruc- 
tions relative to B. C. L. 34 

Instructions relative to 

preparation of B. C. L. 7 

Necessity for exigency 
purchases to be given 
on face of B. C. L. 25 

Navy patients B. C. L. 138 

Pay voucher for commuta- 
tion of quarters B. C. L. 78 

Preparation of, for gas, 
electric current, and wa- 
ter B. C. L. 67 

Preparation of, for reim- 
bursement of travel ex- 
penses B. C. L. 85 



Vouchers — Continued. 

Rendered in favor of 
apothecaries for medi- 
cines B. C. L. 26 

Travel, prompt rendering 

of B. C. L. 44 

War-risk patients B. C. L. 138 

W. 

Ward, Surg. Hugh David, 

obituary notice of B. C. L. 157 

Wards, psychopathic, general 

hospitals B. C. L. 182 

War, supplies for use in Public 

Health Service hospitals B. C. L. 158 

War-risk insurance : 

Admission of beneficiaries 
of, to service relief sta- 
tions B. C. L. 159 

Appropriations of B. C. L. 174 

Care and treatment of 

patients on account of B. C. L. 126 

Expenditures chargeable to 

appropriations of B. C. L. 174 

Mental patients of B. C. L. 181 

Treatment of beneficiaries 

of B. C. li. 150, 184 

Treatment of neuropsy- 

chiatric patients of B. C. L. 182 

War - risk transportation 

requests B. C. L. 217 

Water, preparation of vouchers 

for B. C. L. 67 

Window shades, inspection of- B. C. L. 71 
Workmen's compensation act B. C. L. 107 

X. 

X-ray technicians, appointment 

of B. C. L. 226 



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